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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />t _ , (612) 473-739& <br />Owner 1 ",/ <br />Contractor <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FLT: <br />Inside Plumbing ( # fixtures ) <br />NEW ❑ ADDITION <br />Fee $_ <br />Watt:r Meter (Si/e ) Fee $ <br />Meter It <br />Remote 1) <br />Municipal Water Connection Fee $ <br />❑ Copper ❑ <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast ❑ <br />MWCC SAC Charge Fee $ <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, Including 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 don <br />not grant any authority to do work or activities requiring <br />separate 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 ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to inspection• approval or relection 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 Applicant <br />CITY PERMIT NO. - 74191 <br />Date <br />EV <br />Address (0 1 0 �-- <br />Address a� /1 <br />State License No. <br />❑ REPAIR <br />Or Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Fee $ <br />Fee $ <br />Fee $ <br />Fee $ <br />Other: Fee $ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: Fee $ <br />Total Amount Paid to City Fee S 36• v v <br />This permit ', not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Sign • of City Official <br />�ti��Zl t <br />Code: White -I tic Copy Canary Inspector's Copy Pink -I inance Copy Gold --Applicant's Receipt <br />