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GENERAL PERMIT CITY PERMIT NO.76789 <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 553 <br />(612) 473-7357 �/• 5,� <br />Owner Address A9 �V % <br />&t2zp <br />n / <br />Contractor &ager Address <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: NEW <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 S <br />❑Copper <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast r7l <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit. Including acceptance of an special Information. <br />terms. conditions or requirements written above. The <br />undersigned understands and agrees under psna&ty of law <br />that thts permit is strictly limited In scope to the work. <br />activity or Improvement spadfled; that this permit does <br />not grant any authority to do work or activities requiring <br />separate permit approvals; and that thts permit does not <br />grant authority to violate my 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 regulation &. and shall be <br />subleet to Inspection, soproval or refection by the City. <br />Whenever so ordered, the undersigned ogees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature f Applic nt <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 />Other: <br />After -the -fact Investigation <br />TOTAL <br />Fee S <br />25700 <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />State Surcharge: Fee S o <br />Total Amount Paid to City Fee S_.�1T <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Sig a of Of <br />Code: White - File Copy Canary -Inspector's Copy Pink -Finance Copy Gold --Applicant's Receipt <br />