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CITY PERMIT NO. —682, <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(6 12) 473-731I57`` <br />Owner irm. NEt Address �`7 � CF V R � et A 51 Or <br />Contractor 1 `7 Address r �00 <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: XN EW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size <br />Meter # _ <br />Remote # _ <br />❑ ADDITION ❑ REPAIR <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S a� w <br />,Copper <br />�n <br />Municipal Sewer Connection Fee $ 0, <br />❑ PVC Wast n <br />nr� <br />MWCC SAC Charge Fee $ja , <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of c ,_, y %-.atlon, <br />terms, conditions or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />that this permit is strictly limited in scope to the work, <br />activity or Improvement specified; that this permit does <br />not grant any authority 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 State law, rule or regulation. All work shall be <br />done In strict r'imuliance with all City ordinances, building <br />codes—.di,,, health department regulations, and shall be <br />subject to inspection, approval or rejection by the City. <br />Whenever so ordered, the andersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature oy.Mp <br />Code: White—tile Copy Canary -- Inspector's Copy <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />Stat, Surcharge. <br />Total Amount Paid !() City <br />Fee S <br />Fee $ <br />Fee $ <br />Fee S <br />Fee $ <br />Fee S <br />Fee $ <br />Fee S /.00 <br />oe <br />Fee $ _ <br />This permit is not valid until the proper fee is paid and I <br />it is approved by an authorized City Official. <br />Signaturr.yf City <br />Pink I inance Copy (Iold Apphrant's Receipt <br />