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GENERAL PERMIT CITY PERMIT NO. _-6990 1 <br />CITY OF ORONO <br />P,O.BOX 66 Date S — a G <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner ,.k �u.a.��,.. Address _ 3 6 F&AtYdJLR �— <br />Contractor _- �T e-t�t -� - Address /S 3 d (0 7 <br />City Licease No <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing ( M fixtures ) Fee S <br />Water Meter (Size ) Fee S <br />Meter # <br />Remote #f <br />Municipal Water Connection Fee S <br />❑ Copper <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast ❑—__ <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby aeknowtedges receipt of this limited <br />permit. including aecsptande of ali 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 />activil• or improvement specified: that this permit does <br />not p'uvt any authority to do •.ork or activities requiring <br />s "ate nermtt approvals. and that this permit does not <br />Grant au thonty to vi"late any provision of any Citv <br />urdmance or State lsw, rule or regulation. All work shut be <br />done in strict compliance with all City ordinances, buticimit <br />codes and/or health department regulations, and shall be <br />w+bioet to inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be ut violation of the conditions of <br />this permit. <br />SignaWn ul' Applicant <br />State License No. <br />❑ REPAIR <br />On Site Septic System Fee S <br />Water Well Fee S 90 a G0 <br />Mechanical Equipment Fee S <br />Moving/Lifting Buildings Fee S <br />Land Alteration (Excavation, Fee S <br />Grading, Filling, etc.) <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee S e SO <br />Total Amount Paid to City Fee S a(J it 60 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatur, of City Official <br />Code White file Copy Canary Insptti tnr'v C"pv — Pink I inance Copy Gold Applicant's Receipt <br />