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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(6 12) 473-7357 <br />CITY PERMIT NO. 6822 1 <br />Date 7 --t?P, -2- <br />Owner PAVC– q ��2-�ic1 cin Address kG t e��u #d <br />I <br />Contractor __WldmE2 E)rvA4 Address �` r t Nn �A1Z <br />City License No <br />REMARKS AND SPECIAL CONDITIONS <br />?J0\032 78, <br />R�ffu►e"r i Z C;., 3so V 7,5, <br />PERMIT TYPE AND FEE: ❑ NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size V) <br />Meter # 301632-77C <br />Remote# 12G3S475 <br />❑ ADDITION <br />Fee S_ <br />Fee $_L0 <br />tie) <br />M^nicpa <br />'l Water Connection Fee S -01 <br />Copper <br />:Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast Q— <br />M%%'CC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned hereby acknowledges receipt of this limited <br />permit, uicluding acceptance of all special information, <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 pennit 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. AU work shall be <br />dune 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 />Wbenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of the eonditlons of <br />this permit. <br />Signature of Applicant <br />State License No. <br />❑ REPAIR <br />On Site Septic System Fee S <br />Water Well Fee S <br />Mechanical Equipment Fee S <br />Moving/Lifting Buildings Fei. $ <br />Land Alteration (Excavation, Fee $ <br />Grading, Filling, etc.) <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S . Y( <br />JU <br />Fee S '/ <br />This permit is not valid until the proper fee is paid and I <br />it is approved by an authorized City Official. <br />Signatur4 of City <br />Code: White file Copy Canary Inspector's Copy Pink --Finance Copy Gold - Applicant's Receipt <br />