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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473.7357 <br />CITY PERMIT NO. 8034 <br />Date e' e / v <br />Owner &L, nazia Address <br />Contractor �[ r�0[7 WWI Ot)To t J Address <br />City License No. c 7 L State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing (Mixtures_) <br />Water Meter (Size—) <br />Meter#/ <br />Remote <br />NEW ❑ ADDITION <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S <br />❑Copper F1 <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge Fee S <br />On Site Septic System Fee S <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 does <br />not grant any authority to do work or activities requiring <br />separate permit approvals; and that this permit does not <br />grant wthority to violate any provision of any City <br />ordinance or State law, Wile or regulation. Ali work shall be <br />done in rfrtet 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 />Whenever so ordered, the undersigned agree to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature of Applicant <br />ti � kJ <br />❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire <br />Sprinkler System (Fire) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S 2 n 00 <br />Fee S <br />Fee S <br />Fee $ <br />Fee <br />$ <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee S ' <br />Fee S� <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Offici �6P <br />Code: White —File Copy Canary - Inspector's Copy Pink —Finance Copy Gold —Appticant's Receipt <br />