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CITY PERMIT NO. 8319, <br />GENERAL PERMIT <br />CITY OF ORONO t c <br />P.O.BOX 66 Date_ <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner 1 Cn. AC- Address a5?Ct) <br />Contractor Address > a C<_) <br />City License No. IS__7 State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: 4I NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing (#fixtures_) Fee S <br />Water Meter (Size_) <br />Meter# <br />Remote <br />Municipal Water Connection <br />❑Copper n_ <br />Municipal Sewer Connection <br />❑ PVC ❑ Cast <br />MWCC SAC Charge <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fee S____ <br />_ <br />Fee S ------ <br />Fee S _ - <br />n <br />Fee S _ <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of sill special :nforrnation, <br />terms, conditions or requirements wdtten above. The <br />undersigned understands and agrees under penalty of law <br />V,..at thls permit is strictly limited In scope to the work, <br />activity or Improvement specified; that this permit does <br />not grant .sty 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 />subK-t to Inspection, approval or rejection by the City. <br />Whet.• cr 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 />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire - _ <br />Sprinkler System (Fire) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee S ' 50 <br />so <br />Fee S��t <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 Official <br />j <br />Code. Wh c File Copy Canary -Inspector's Copy Pink -Finance Copy Gold - Applicant's Receipt <br />