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GENERAL PERMIT CITY PERMIT No. _-69821 <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL HAY, MINNESOTA 55323 <br />(612) 473-7357 Owner �Ay _ JO1p1Anro, Address -/ Q <br />m 1)AK-43TJ%­ Av E <br />Contractor ,1 \i7 O LA \J,)U �- Address MTK& l M%y\n <br />City License No <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />State License No <br />❑ NEW ❑ ADDITION AREPAIR <br />Inside Plumbing( M fixtures ) Fee S I On Site Septic System <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />Fee S <br />Municipal Water Connection Fee S <br />❑Copper n <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of W sjeetal information, <br />terms, conditions or requiremenla written above. The <br />undersigned understands and agrees under penalty of law <br />that " permit is strictly United in scope to the work, <br />activity of improvement specified; that this permit does <br />not grant any authority to do wort 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 re regulation. AU work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulaUoaa, and shall be <br />subject to inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be to violation of the conditions of <br />Nis permit. <br />Signature of Applicant <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 />Fee <br />S <br />Fee <br />S .101 06 <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />State Surcharge: Fee S 2 0' <br />Total Amount Paid to City Fee S <br />This permit is not valid until the proper tee is paid anti <br />it is approved by an authorized City Official. <br />Signatupy o <br />v <br />Code White - File Copy Canary Inspeca.r's Copy Pink I mance Copy Gold Applicant's Receipt <br />