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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOx 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(61 _') 473-735 <br />CITY I+RMIT NO. 72641 <br />Date 12-6 - ?**� <br />Owner _ _ l OM J�E-'/-Z Address 1-115,— "C/ VLC- <br />Contractor —6" S`rCyo COLA (/Oe-LCL Address M-715 4 <br />City License No, <br />REMARKS AND SPECIAL CONDITIONS <br />State License No. <br />i!oiP Y o F S 7-i i!,j L IC e_r, i�_L� m r y <br />PERMIT TYPE AND FI-F.: 9NFW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter 4 _ <br />Remote # <br />❑ ADDITION <br />Fee $ <br />Fee S <br />Municipal Water Connection Fee S <br />❑ Copper E.. <br />Municipal Se%kvr Connection Fee S <br />❑ PVC' ❑ cast Q <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <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 wthority to do work or ectivtUes requiring <br />separate perm 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. All work shail 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 re►ecUon by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be of violation of the conditions of <br />this permit. <br />Signature ol' Applicant <br />( udc 'Ahite I de ropy <br />❑ REPAIR <br />On Site Septic System <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 S <br />1=ee <br />$ <br />Fee <br />$ <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />State Surcharge' Fee S S01 <br />Total Amount Paid to Cit. Fee S --' <br />This pennit is not valid until the proper tee is paid and <br />it is approved by ar •uthorized City Official. <br />Signature of Cjty Officia <br />Canary Inspector's Copy Pink I inance C'op� (,oid Applicant's Receipt <br />