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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. 73A I <br />Date 1 - ! - 94' <br />Owner 1 <br />awn lsbE-T -Z <br />Address <br />q / 5- 11- both <br />Contractor SiFV <br />E *-X&6.LL <br />Address <br />E CA L AJ &d t ate- M k'=- . <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />INI A SCAR ---"Air W 1PL (ZE V"CI Is- F <br />PERMIT TYPE AND FEE: NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter M <br />Remote # <br />❑ ADDITION <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S <br />[]Copper ❑ <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast ❑ <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 />•tms, conditions or rccuirementa 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 />aettvity or improvement speclfird; 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 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 impaction, 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 />f <br />t <br />Signature of Appl,..a t <br />State License No. <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 />Fee S <br />r. n <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />State Surcharge: Fee S 16-0 <br />Ir 5,0 <br />Total Amount Paid to City Fee $ <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 <br />I <br />Code: White File Copy Canary Inspectw's Copy Pink Finance Copy Gold Applicant's Receipt <br />