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CITY PI:RMI� "°. --s73g i <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOx 66 Datc <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner u%e Address / <br />Contractor Address <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />State License No. <br />-� L o-)g lu - S�_e r a!y� ado <br />PERMIT TYPE AND FEE: ❑ NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter M <br />Remote # <br />Municipal Water Connection <br />❑ Copper <br />Municipal Sewer Connection <br />❑ PVC ❑ Cast r1 <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />❑ ADDITION ❑ REPAIR <br />Fee $ I On Site Septic System <br />Fee $ I Water Well <br />Fee $ <br />Fee $ <br />Fee $ <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 @hall 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 />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />Fee <br />S <br />Fee <br />S <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />S <br />Fee <br />$ <br />State Surcharge: Fee S <br />Total Amount Paid to City Fee 4�, <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 Applicant -J - Sign t rc of CitY�0 <br />ri•n, jL <br />Code: White -I ile Copy Canary Inspector's Copy oink Finance Copy Gold Applicant's Receipt <br />I <br />