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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL 3AY, MINNESOTA 55323 <br />(512)473-7357 <br />CITY PERMIT NO. 8179, <br />Date i�l <br />0,_,nor iOki / i�(_ %lll'L/liL Address <��`�1 l�lL%�/6<-1 l !/7 17d <br />Contractor �' '1 �u � /in:21 :7) Address C O ' -1 4,1 <br />City License No. 1�) rl State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />ide Plumbing Ofixtures_) <br />,NEW ❑ ADDITION <br />Fee S I <br />er Meter (Size_) Fee S <br />Meter# <br />Remote <br />cipal Water Conne,.tion Fee S —. <br />❑Copper ❑ <br />ipal Sewer Connection <br />PVC ❑ Cast <br />SAC Charge <br />Septic S� stem <br />)WLEDGEMENT <br />Fee S _ - <br />❑ <br />Fee S - - <br />Fee S ' f. <br />to undersigned hereby acknowledges receipt of chis limited <br />rmit, including acceptance of all special information, <br />ms, conditions or requirements written above. The <br />ie:4ned understands and agrees under penalty of law <br />t this permit is strictly limited in scope to the work, <br />vity or improvement specified; that this permit does <br />grant any authority to do work or activities requiring <br />rate permit approvals; and that this permit does not <br />t authority to violate any provi,!on of any City <br />ranee or State law, rule or regulation. All work shall be <br />In strict compliance with all City ordinances, building <br />and/or health department regulations, and shall be <br />!t to Inspection, approval or rejection by the ray. <br />• er so ordered, the undersigned agrees to correct <br />•ork found to be in violation of the conditions of <br />rmit. <br />')"'/, <br />plicant <br />Z u l <br />❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fire Fee S <br />rinkler System (Fire) <br />her: <br />ter -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S <br />Fee S <br />'13 <br />Fee S *' r_ <br />Fee S 7�S <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />SignatW of City Official <br />(lode White I ile Copy Canary Inspector's Copy Pink A inance Copy <br />a <br />Gold -Appiicant's Receipt <br />