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Y <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />3 CRYSTAL BAY, MINNESOTA 55323 <br />(E 12) 473-7357 <br />CITY PERMIT NO. 8221 <br />Date f `t r �� <br />Owner Address __ Otc—Lpj L L i <br />Contractor d I J21 `��iy�VC' `� IN P4 Address 1 WL i <br />111) <br />City License "o. � l7� State License No. I <br />REMAhxS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing (Mixtures_) <br />Water Meter (Size _) <br />Meter# <br />Remote <br />❑ NEW ❑ ADDITION ❑ REPAIR <br />Fee S Water Well <br />Fee S.----- Mechanical Equipment <br />(Moving /Lifting Buildings <br />Municipal Water Connection Fee S —_ <br />❑Copper n _ <br />Municipal Sewer Connection Fee S _— <br />❑ PVC ❑ Cast <br />M WC C SAC Charge Fee S — <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowiedp receipt of tbla umlted <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 sc Ppe to the work, <br />activity or iriprovement 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 regulctlon. All work &hall be <br />done in strict compliance with all City ordinances building <br />_ (Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Fee S <br />Fee S <br />Fet: S <br />Fire _ Fee S I <br />f,rinNer System (Fire) <br />Fee S <br />her: Fee $f <br />er-the-fact 11-vestigation Fee S <br />TOTAL <br />State Surchar.e. <br />Total Amount Paid to City <br />Fee S <br />Fee S smolt_ <br />codes and/or health department regulations, and shall be This permit is not valid until the proper fee is paid and ' <br />subject to inspection, approval or rejection by the City. it is approved by an authorized City Official <br />Whenever so ordered, the undersigned &act& to correct <br />any wotk found to be in %iolation of the cu ditions of <br />this permit. I <br />i <br />Signature of Applicant Signature giCity Official 1 <br />�� zo.�) K;�� <br />Code. White - File Copy Canary--lnspectot's Copy Pink -Finance Copy Gold -Applicant's Receipt <br />