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GENERAL PERMIT <br />CITY OF ORONO <br />CITY PERMIT NO. 6611 <br />P.O.BOX 66 <br />Date /—/l—,P <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner/�)ehAddress �L� G ��%��D U A& <br />Contractor / Address <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: X NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />❑ ADDITION <br />Fie $ <br />Fee $ <br />Municipal Water Connection Fee $ _ <br />❑ Copper <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast Q <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned hereby 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 apees 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 perms: does not <br />grant authority to violate any provision of any City <br />ordinance or State law, rule or regulation. All work &hall 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 />Signature of Applicant <br />State Licen,�� 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 <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Other: Fee $ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: Fee $ •Sn <br />Total Amount Paid to City Fee $ <br />This permit is net Valid anti! the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signa ure of City Official <br />Xky21_31 1-1 <br />Code. White -File Copy Canary Inspector's Copy Pink- Finance Copy Gold Applicant's Receipt <br />