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GENERAL PERMIT CITY PERMIT NO. 8457 <br />CITY OF ORONO <br />P.O.BOX 56 Date j <br />CRYSTAL BAY, MINNESOTA 55323 ` <br />16121473-7357 <br />Owner ia eFe o 4X -Address <br />Contractor <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />dAA. a..ci_ n (,a It j <br />PERMIT TYPE. AND FEE <br />Inside Plumbing (#fixtures_) <br />Water Meter (Size—) <br />Meter# <br />Remote N <br />❑ NEW ❑ 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 Fee S___ <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Address <br />State License No. <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 />Fee S IAfter-the-fact Investigation <br />The undersigned hereby acknowledges receipt of this limited <br />permit, Including acceptance of Alispecial Information. <br />terms, conditions or requirements written above. The <br />undenlgned understands and agrees under penalty of law <br />that alis permit is strictly Limited In scope to the work, <br />activity u. improvement specified: that tuts permit doe, <br />not grant any authority to do work or activities repuiri ig <br />sePara <br />te pe.i�" approvals: and that this permit does not <br />Rant autbOYlLY to violate any provision of any City <br />ordinance or State law, rule or regWatlon. All work stall be <br />done in strict compliance with all City ordinances, building <br />codes and,or health department re"UOns, and shall be <br />suWect to inspection, approval or relection by the City. <br />Whenever so ordered, the undersiyied agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature o <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S <br />Fee S <br />Fee S 5-0. ad <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee S <br />Fee S so. S-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 Ci Official <br />�J <br />Code White-FdeCopy Canary Inspector's Copy Pink - Finance Copy Gold Applicant's Receipt <br />