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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 60 <br />CRYS1 AL BAY, MINNESOTA 55323 <br />(61 _) 473-7357 <br />Owner V,4,e- Address <br />('ITY PI RMIT NO. + 7468 <br />('ontrat: tor -ILt LL) %A4N-' Address _ ^ <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />Date -/ - 4 F;,'V <br />State License No <br />-- S L(J ?Tz-4 OyLs^- Lc.tity 772) t-kr11,K_ <br />PERMIT TYPI- AND FI.F.: ❑ NF:W <br />Inside Plumbing I .!? listures I <br />❑ ADDITION <br />Fee S <br />Water ,Meter (Site ) Fee S <br />Meter 4 _ <br />Remote td <br />Municipal Water Connection Fee S <br />❑Copper Q__ <br />Municipal Se%cr (ouncction Fee S <br />❑ PVC ❑ (.ast Q___. <br />MWCC SAC('harl'e Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />Permit. including acceptance of all special information, <br />terms, conditions or requiremen is written above. The <br />undersigned understands and agrees under penalty of taw <br />that this permit is stricd> limited in scope to the work, <br />activity or improvement specifted: that this permit does <br />not giant any autinority to do work or activities requiring <br />sepamit approvals: and that this permit does not <br />rate per <br />Rant authonty to violate anv provision of any City <br />ordinance or State law, rule or regulation. Ali work shall be <br />done m .tract compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to Inspection, approval or relection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />env work found to be to violation of the conditions of <br />this permit. <br />Signa of Ap ,:ant r <br />OEPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling!, etc.) <br />0.0 <br />Fee S 3O j <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Other: Fee S <br />After -the -tact Investigation Fee S <br />TOTAL <br />S-a <br />State Surcharge: Fee S <br />STa <br />Total Amount Paid to City Fee S r <br />This permit is not valid until the proper tee is pair) and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />tonic While I de tbpy Canary In". ctor's Copy Rnk I inante Cop% t,uld Applirant'v Reccipt <br />