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GENERAL PERMIT CITY PERMIT NO.--71311 <br />CITY OF ORONO <br />P,O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner 4141 oc `I Address <br />Contractor �S�ac(I it���/I (i Address_ 29 66 <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />State License No. <br />PERMIT TYPE AND FEE: [2 NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size ) Fee $ <br />Meter # <br />Remote # <br />Municipal Water Connection Fee $ <br />❑ Copper ❑ <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Ca it ❑ <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of W 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 />grant 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 andjor health department regulations, and shall be <br />sublect to inspection, approval or refection 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 />On Site Septic System Fee S <br />Water Well Fee S , U • GU <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 s� <br />Total Amount Paid to City Fee S, Ul �C) <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />I <br />Code White - File Copy Canary - Inspector's Copy Pink I inance Copy Gold Applicant's Receipt <br />