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GENERAL PERMIT CITY PERMIT NO. 8386 <br />.CITY OF ORONO _ j -V6 <br />P.O.BOX 66 date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner An exe,la_ Address <br />Contractor aD,C1 STL) L 'U �a ` �� Address S 3oG &hu4 M <br />J L <br />City License No. ( State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ;@ NEW <br />Inside Plumbing (#fixtures_) Fee S <br />Water Meter (Size_) Fee S <br />Meter# <br />Remote 1 <br />❑ ADDITION <br />Municipal Water Connection Fee S — <br />❑Copper n <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge Fee S <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />IFire Fee S <br />Sprinkler System (Fire) <br />Fee S <br />-1Other: Fee S <br />Fee 5 lAfter-the-fact Investigation Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />teems, 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 violet. any provision of any City <br />ordinance or State law, rule or regulaUon. All work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shell 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 Applican� <br />TOTAL <br />State Surcharge: Fee $ • 40 <br />Total Amount Paid to City Fee $ > • Sv <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 />Curie. White i de Cupy Clinary Inspector's Copy Pink A inance Copy Gold -Applicant's Receipt <br />