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M , <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 5532-3 <br />(612) 4733-7357 <br />Owner l—Qnc _ <br />Contrdctor 5 1,4-6-1. _ <br />City License No. C:?>vn <br />REMARKS AND SPECIAL CONDITIONS <br />CITY PERMIT NO. 8217 <br />Date <br />Address -7�2� ' 'ti a , Or . <br />Address r 1 B oy 7-5— kcr-1-. f d <br />State License No. <br />PFRMIT TYPE AND FEE: )0 NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing (#fixtures_) Fee S <br />Water Meter (Sire _) <br />Meter # <br />Remote <br />er Well <br />Fee S IMechanical Equipment <br />Muni —pal Water Connection Fee S <br />❑Copper 13 _ <br />Municipal ,ewer Connection Fee a _ <br />❑ PVC ❑ cast G—_ <br />MWCC SAC Charge Fee S _. <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special Information, <br />terms, condaoos or requirements anitten above. The <br />undersigned understands and agrees under penalty of law <br />that this permit is strtcUv limited In scope to the work, <br />activity or improvement specified; that this permit does <br />not grant any authority to do work or activtties requiring <br />separate permit approvals; and that this permit does not <br />grant authority to violate any pro,islon of any City <br />ordinance or State law, rule or regulation. All work shall be <br />done In strict compliance with all CAv ordinance►, building <br />codes andlor health department regulations, and shall be <br />subject to Inspection, approval or rejection by the City. <br />Whenever at) ordered. the undersigned agrees to correct <br />any work found to be in volauon of the condluons of <br />this permit. <br />Signature of Applicant <br />P� <br />Code: White -FUeCopy Canary-Inapector's Copy <br />oving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S �• <br />Fee $ <br />Fee S <br />Fee $ <br />re Fee $ <br />rinkler System (Fire) Fee s <br />her: Fee S <br />e-fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee $ ' �t� <br />Tutal Amount Paid to City Fee $ '30• <br />This permit is not valid until the proper fee is laid and <br />it is approved by an authorized City Official. <br />Signature of City Offi <br />Pink -Finance Copy Gold-AppBaftt's Receipt <br />