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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />CITY PERMIT NO. 6909 1 <br />Date / a - A/ - 9.;7- <br />Owner Address _l :'� �� s /�' J,�r�>•n_ S� <br />Contractor rkf3, d Address -5' 0 &-23�4 <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE. AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee S <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />Fee S <br />Municipal Water Connection Fee S <br />❑ Copper <br />Municipal Sewer Connection Fee S �U <br />❑ PVC ❑ Cast <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <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 />Other: <br />Fee SDI After -the -fact Investigation <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 ;aw <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 atrict compliance with all City ordinances, building <br />codes andlor 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 to violation of the conditions of <br />this permit. <br />Signatu of Ap licant <br />Code: ite—Pile Copy Canary- Inspector's Copy <br />TOTAL <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />State Surcharge: Fee S . S0 <br />Total Amount Paid to City Fee S s• SU <br />This pennit 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 />Pink I inance Copy Gold Applicant's Receipt <br />