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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />CITY PERMIT NO.8169 <br />Date <br />Owner <br />Contractor / Ka t ie <br />/City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />Address 0 h ■ <br />Address / 3^7S' ^JCfA Oi'e^LKd f){^< <br />State License No.______C _i___________ <br />PERMIT TYPE AND FEE: <br />Inside Plumbing (#fixtures —) <br />Water Meter (Size__) <br />Meter#______________ <br />□ NEW □ ADDITION □ REPAIR <br />Fee S <br />Fee S <br />Remote #, <br />Municipal Water Connection <br />OCopper Q____ <br />Fee S <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Gr; ding. Filling, etc.) <br />Municipal Sewer Connection <br />□ PVC □ Cast Q <br />MWee SAC Charge <br />On Site Septic System <br />Fee S — <br />Fee S <br />Fee S. <br />Fire <br />Sprinkler System (Fire) <br />Other:_____________ <br />After-the-fact Investigation <br />Fee $- - - - - <br />Fee <br />Fee $_ _ _ _ _ _ <br />Fee S- - - - - - <br />Fee $_ _ _ _ _ _ <br />Fee $_ _ _ _ _ <br />Fee S_ _ _ _ _ <br />Fee S_ _ _ _ _ <br />ACKNOWLEDGEM ENT <br />Th® undersigned hereby acknowledges receipt of this limited <br />pennit, including acceptance of ail special information, <br />terms, conditions or requirements written above. The <br />underdgned rnderstands and agrees under penalty of law <br />that lUU permit is stricUy Umited in scope to the work, <br />activity or improvement specified: that this permit does <br />not grant any author!^ to do work or activities requiring <br />separate permit approvals: and that this permit does not <br />grant authority to violate any provision of any City <br />ordinance or SUte law, rule or regulation. All work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature of Applicai^ ^ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $ <br />Fee It. ^ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature^^fC/'y Officials .. <br />Code: Whitc-l Uc Copy CtnMy-Iinpecior't Copy Pink -t-inance Copy ild-AppUcant'i Receipt <br />I