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GENERAL PERMIT CITY PERMIT NO. 7961 <br />CITY OF ORONO -A0 s� <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55.323 <br />(612) 473-7357 <br />Owner�4 ddress -**')J() <br />� <br />2 <br />Contractor t Bla "� Address <br />City License Nn. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FL!:: ❑ NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing (#fixtures_.) Fee S <br />Water Ds ter (Size—) Fee S <br />Meter # <br />Remote # <br />Municipal Water Connection Fee S — <br />❑Copper Q <br />Municipal S. wer Connection Fee S — <br />❑ PVC ❑ Cast <br />MWCC SAC Charge <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Lan,' Alteration (Excavation, <br />C ading, Filling, etc.) <br />Fire <br />sprinkler System (Fire) <br />Fee S _ ___ _ (Other. <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit, i_,cluding acceptance of all special information, <br />terms, conditions or requirements written ab(we. The <br />undersigned understands and agrees under penalty of law <br />that this permit is stnc�ly It, <br />ited in scope to the work, <br />activity or improvement speeifted; that this permit does <br />not grant -ni, 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 />subiect to inspecucn, approval or re)ecuon by the City. <br />Whenever so orden.d, the undersigned agrees to correct <br />any work tour u w be in violation of the conditions of <br />this permit. <br />Signature of Applicant <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee a <br />Fee S <br />Fee S <br />ter -the -fact Invest:oation Fee S <br />TOTAL <br />State Surcharge: Fee S . _y_ ) <br />Total Amount Paid to City Fee S 3d,SD <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Sign > of City Offic <br />* j t <br />Code. White File ropy CanarY-Itupticttx'sCOPY Pink -Finance Copy Gold -Applicant's Receipt <br />