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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />CITY PERMIT NO. 67281 <br />Date <br />Owner t!-WA I-e-S ,�A-LCy4�4-�7, Address 3'l.3S- eFA4-r/-4X,-- S-r- <br />Contractor -3 L0*j?:±1 �1 d k�/�O/l/ Address /►' &ig"A <br />City Licens- No. <br />REMARKS AND SPECIAL CONDITIONS <br />State License No <br />�401-E JVAJe, / .O.st!-A'- A<00 a-, Y.0 (AT lne!Oe- e0UAJca-A<Tuw 1 <br />PERMIT TYPE AND FEE <br />Inside Plumbing( # fixtures <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />NEW ❑ ADDITION <br />Fee $ <br />Fee $ <br />Municipal Water Connection Fee $ <br />❑Copper ❑—_ <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ cast n_ <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned herety acknowledges 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 penalty of law <br />that this permit is strictly limited in scope to the work, <br />activity or improvement 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 />gm -it 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 />subject to inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signatur Applicant <br />i <br />❑ REPAIR <br />On Site Septic System Fee S 3 <br />Water Well Fee $ <br />Mechanical Equipment Fee S <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation, Fee $ <br />Grading, Filling, etc.) <br />Other: Fee S <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $ S� <br />Fee $ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Si ure of City Offiri <br />Code. White A lie Copy Canary -Inspector's Copy Pink - I inance Copy t Iold Apphrant's Receipt <br />