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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. 7710 <br />Date <br />Owner �1.7f' !�— Address 4- n a ! w 0 41 4:e444 <br />Contractor ^ 1,,,4 r nr Z� Address ��Q Ol✓ ' <br />If f <br />City License No. r-;? d (9S State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />Ql 1 Dn 039 21- k S. (- ,are- e o s4 // C? o � � � Cjk/'rx icy <br />iV l j CZ le • -J rzT �� r— %al _ ky e� i- i _ n ✓�L� <br />PERMIT TYPE AND FEE <br />Inside Plumbing Wixtures_) <br />Water Meter (Size _) <br />Meter <br />Remote <br />❑ NEW ❑ "EDITION <br />Fee $ _ <br />Fee S__-_ <br />Municipal Water Connection Fee S ----- <br />❑ Copper n <br />Municipal Sewer Connection Fee <br />❑ PVC ❑ cast (-1 <br />MWCC SAC Charge Fee S <br />GI Site Septic System Fee S 00 <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />lem,s, coudition< or requirements whiten above. The <br />undersigned ut nds and agrees under penalty of law <br />th.' :his perr. trictly limited in scope to the work, <br />actA.cty or imp nent specified: that this perms does <br />not grs,. •,nv authonty to do work or activities requiring <br />separate permit approvals: and that this permit dues not <br />grant authority to violate any provision of any City <br />ordinance or State law• rule or regulation. ALI work shall be <br />done in atrlct cmmpliance with all City ordinances• budding <br />codes andlor health department regulations, 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 In violation of the conditions of <br />this permit. <br />Signature ' Applica <br />Cl REPAIR <br />ater Well <br />anical Equipment <br />/Lifting Buildings <br />Land Alteration (F ;cavation, <br />Grading. Filling, etc.) <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />S <br />in Fee $ <br />.inkler System (Fire) <br />Fee S <br />ther: Fee $ <br />fter-the-fact Investigation Fee $ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $ - C� O <br />Fee S 7'3' ';0' <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 Cit; `Jf Ic: ll <br />,E&JLst, (7,K) <br />Code %'hire -I Ile Cnpy Canary Inspector's Copy Pink -I inance Copy Gold -Applicant's Receipt <br />