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GENERAL PERMIT Cl1-NALRMITNo. -7044, <br />CITY OF ORONO <br />N.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />OwnerAAddress <br />Contractor Alt(Address 0 & 14AJ <br />II City License No. <br />W <br />I <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: kNEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size_) <br />Meter # <br />Remote # <br />❑ ADDITION <br />Fee S <br />Fee S <br />Municipal Water Connection Fee $ <br />❑Copper <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />State License No. <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Fee S 070- 00 <br />Fee S <br />Fee S <br />Fee S <br />Other: Fee S <br />Fee S I After -the -fact Investigation Fee S <br />The understand hereby acaaowlsagN r•c.ivt of thts limited <br />p—it. tneludine Skeaeptaoee of all petal information, <br />tams, cnndltlone or requirements written Sib. va. The <br />endersigad undemlasnds and &grew under penalty of law <br />that " permit Is strieth limited in scope to We wore, <br />activity of improvement Specified: that this pssmlt does <br />not groat any authodty to do work or activities requiting <br />"Palau tarmit approva4: and that this permit does not <br />grant autbosity, to Violate any provtsfon of any City <br />ardinanee or Stara law, rule or regmlation. AD wort shall be <br />dew m eldet ea®pLaoce with all City ordinsncea building <br />nodes an department <br />heath deparent regulations. ad @ all be <br />sublet to Iaspeedoa, approval or ralecton by the city. <br />Whenever to arda ed, the undersigned agrees to correct <br />any wort found to be in violation of the conditions of <br />Shia pesmit. <br />Signature of Applicant <br />TOTAL <br />Mate Surcharge: Fee S <br />Total Amourt Paid to City Fee S� <br />Phis permit is not vand until the proper fee :s paid and <br />it is approved by an authorized City Officidl. <br />Code. White- FW Copy a a.fy .. tntpxtimf's Copy Pint - I inane Copy (kola ,pplicant's Receipt <br />