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GENERAL PERMIT <br />CITY OF ORON 0 <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />' <br />Owner00_,�o <br />Contractor I) 1 �l <br />CITY PERMIT NO. 8088 <br />Date_?- ./ �/ 6'5- <br />Address �� t✓� <br />Address <br />v <br />City License No._ C)l0z�_ _ — State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: <br />Inside Plumbing (#fixtures_) <br />❑ NEW ❑ ADDITION <br />Fee C <br />Wader Meter (Size_) Fee S <br />Meter # <br />Remote#. <br />Muni6pal Water Connectio Fee S 1�U• ( <br />❑Copper-u►,K �r SyAs <br />Municip 1 Sewer Connection Fee S �'y� <br />PVC ❑ Cast ❑,_ <br />MWCC SAC Charge Fee S <br />On Site Septic System Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknr -edges 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 pe^alty of law <br />that this permit is strictiy Urn in scope u, the work, <br />activity or improvement specified: that this permit does <br />not grant any authority to do work or activities requiring <br />separate perm approvals; and that this permit does not <br />grant author ; .t Oulate any provision of any City <br />or"t "Mee or State law, Jule or regulation. AU work shah be <br />dons 'n strict compliance with all City ordinances, hu-i ding <br />cod" and/or heath department regulations, and shall he <br />abject to lnspecti.,n, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work hound to be In violation of the conditions of <br />this permit. <br />Signature f Appli%c•�fit <br />Code White File Copy t anary Inspector's Copy <br />❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fei, <br />Fee S <br />Ft'; S <br />Fee $ _ <br />Fire Fee $ <br />System (Fire) <br />r-the-fact Investigation <br />TOTAL <br />State Surcharge: <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Total Amount Paid to City Fee S (a / <br />This permit is not valid until the proper fee L t and <br />it is approved by an authorized City Official. <br />Sigma re of City O icial <br />Pink -Fbmm Copy Gold -Applicant's Receipt <br />