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GENERAL PERMIT CITY PERMIT NO. _. 7532, <br />CITY OF ORONO ?—)4- <br />P-O-BOX 66 Date — —a <br />CRYSTAL BAY, MINNESOTA 55323 <br />- (612) 473-73W <br />Owner CA -A a <br />Address <br />Contractor Ae"�iezP <br />( dress l <br />City License No.4ate License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # _ <br />Remote M <br />Fee S <br />Fee $ <br />Municipal Water Connection Fee S <br />❑Copper El <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast Q_ <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of this umlted <br />Parrott, including acceptance of all special information, <br />taros, conditions or requirements written above. The <br />undersigned understands and saren under Penalty of law <br />that this Permit is strictly limited to scope to the work, <br />activity of improvement specified: that this Permit don <br />not Rant any authority to do work or activities requiring <br />ro separate Pefil approvals: and that this Permit don not <br />Rant authority to violate any provision of any City <br />oedlnance or State law, rule or regulation. Ali work shall be <br />done in strict compliance with all City ordinances, building <br />codas and/or health department regulations, and shay be <br />subject to Inspection, approval of 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 />Signature of Applicant <br />C01 <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 />Fee S <br />Fee S 3D. 5o <br />Fee S <br />Fee S <br />Fee S <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee <br />Fee <br />S� <br />S 30.50 <br />This pem)it is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Si a of Official; <br />_EW / _I i A. <br />Code White - Pik Copy Canary Inspecior's Copy Pink finance Cop) Gold Applicant's Receipt <br />