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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 />Owner ✓� <br />�] T <br />Contractor .�l`-' <br />City License No. <br />Q mP <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE ' ND FEE <br />Inside Plum' ing (#fixtures_) <br />CITY PERMIT NO. 7915 <br />Date.. I <br />Address _ r>�U X)� <br />Address <br />State License No. <br />NFXV ❑ ADDITION ❑ REPAIR <br />Fee S lWater Well <br />Water Meter (Size _) <br />Fee <br />Meter# — <br />Remote # <br />_ <br />Municipal Water Connection <br />Fee <br />❑Copper ❑ <br />Municipal Sewer Connection <br />Fee <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge <br />Fee <br />On Site Septic System <br />Fee <br />ACKNOWLEDGEMENT <br />S --- <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />S _ <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire _ <br />Sprinkler System (Fire) <br />S - <br />Other: <br />S <br />After -the -fact Investigation <br />The undersigned hereby acknowledges receipt of this limited <br />Permit, including acceptance of W special tnf�rrnation, <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 />grant authority to violate any Provision of any City <br />brdinr ice or State law, rule or regulaUon. Ail work shall be <br />done In strict compliance with all City ordinances, bu.:''­ <br />codes and/or health department regulations, and shall be <br />subiect to inspection, approval or roection 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 />TOTAL <br />State Surcharge: <br />Fee S <br />Fee S <br />Fee S <br />Fee $ 1 <br />Fee S <br />Fee S <br />Fee $ 1 <br />Fee S 1 <br />Fee S_ <br />Total Amount Paid to City Fee S 57, 6D <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />SignatureA City Offkal <br />(t c ; <br />Code: White -- File Cop•, <br />Canar> Inspet tor's Copy <br />Pink --finance Copy Go' i--Applicant's Receipt <br />