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GENERAL PERIVIIT . � CITYPERMITNO. _—�3`�� � <br /> CITY OF ORONO r <br /> P.O.BOX 66 Date `�- ' 2 � ` d� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner � Address � 7� � � /�-� <br /> s -� � <br /> Contractor Address <br /> City License No. State License No. <br /> RF,MARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: (�NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing( # fixtures ) Fee $ On Site Septic System Fee $ <br /> Water Meter(Size ) Fee $ Water Well Fee $ <br /> Meter # <br /> Remote# Mechanical Equipment Fee $� <br /> Miznicipal Water Connection Fee $ Moving/Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Mtinicipal Sewer Connection Fee $ <br /> ❑ PVC ❑ Cast ❑ Other: Fee $ <br /> MWCC SAC Charge Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hereby acknowledges receipt of this limited <br /> pexmit, including acceptance of all special information, <br /> terms, conditions or requirements written above. The r <br /> undersigned understands and a�ees under penalty of law State SUTC�1dTge: Fee $ ^ v � <br /> that this permit is strictly limited in scope to the work, <br /> activity or irnprovement specified; that this permit does <br /> not grant uny authority to do work or activities requiring Total Amount Paid to City Fe8 � ��. �Q <br /> sepazate permit approvals; and that this Permit does not <br /> �rant authority to violate any provision of any City <br /> ordinance or State law,rule or regulation. All work shall be <br /> done in strict compliance with all City ozdinances, building <br /> codes and/or health department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, apProval or reiection by the c�cy. it is approved by an authorized City Official. <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 /> Sig e of Appl ca � " Signature of City Official <br /> � ���L� � C� � <br /> Code:White—File Copy Canazy—Inspectur's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />