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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />1612 473 7357 <br />CITY PERMIT NO. 7508 1 <br />Date 7-/6 g�Z <br />A. <br />Owner iW�t-U S COAIS.Address __ Z Zws pL /",y <br />ContractorQrT71/dno� �P_oS Address �� Z e_4R Gr bIt.` -',�-- <br />City License No <br />REMARKS AND SPECIAL CONDITIONS <br />State License No. <br />pfou&?I�N SY SrZE-ZK Pew -ye, <br />1D,ftV X> S - 3 - Py <br />PERMIT TYPE AND FEE: XNEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # <br />Remote N <br />❑ ADDITION <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S <br />❑Copper n <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast n <br />MINCC SAC Charge Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />Permit. including acceptance of all special Information, <br />terms, conditions of 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 authority to do work or activities requiring <br />sepamte 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 inspection, approval or rejection by the City. <br />Whenever to ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature of Applicant �J <br />❑ REPAIR <br />On Site Septic System Fee S <br />Water Well Fee S <br />Mechanical Equipment Fee S <br />Moving/Lifting Buildings Fee S <br />Land Alteration (Excavation, Fee S <br />Grading, Filling, etc.) <br />Other: SC-PnC— L--IC-ts*S (:F Fee S Z1� <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee S S� <br />�b <br />Total Amount Paid to City Fee S4)ro <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signat_UM of City Official <br />Code White I ilc (up) Canary Inspet t,-r's Copv Pink F inance Cop) Gold Applicant's Receipt <br />