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GENERAL PERMIT CITY PERMIT NO. --6908 I <br />CITY OF ORONO <br />66 Date IZIlk- <br />P.O.BOX <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner A ()Q-tl. Address �� f ac KIidi-IJ _ <br />Contractor & AiL o. L%jV - Address '—LCJ 8 341Nau <br />City License No. __�lo �f L�� State License No. 1 u <br />RLMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />Fee $ <br />Municipal Water Connection Fee $ <br />[]Copper ❑ <br />Municipal Sewer Connection Fee $_ <br />❑ PVC 0 Cast ❑ <br />MWCC SAC Charge Fee $ , o J <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />terms, conditions or 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 />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 />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 />Si$natu of (plic t <br />G <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: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee S . 50 <br />Total Amount Paid to City Fee S 1/yr. fQ <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 />Code: White -I'de Copy Canary Inspector's Copy <br />Pink I tnance Cop> Gold Applicant's Receipt <br />