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CITY Pt:RMIT NO. --6g0$ <br />GENERAL PERMIT <br />CITY OF ORONO <br />Date <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />j (612) 473-7357 <br />Owner Address <br />I <br />Contractor �A%�w C ��ti �✓A Address sL <br />City License No, <br />REMARKS Ai ID SPECIAL CONDITIONS <br />PERMIT TYPE AND FETE: pd NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />Fee $ <br />Municipal Water Connection Fee S <br />[]Copper <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />terms, conditions or requirements written above. The <br />undersigned understands and agrees under penalty 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 and/or health department regulations, and shall 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 />Signatu Volpplicant <br />State License No <br />❑ REPAIR <br />On Site Septic System Fee $ 3 5,1) <br />Water Well Fee $ <br />Mechanical Equipment Fee $ <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation, Fee $ <br />Grading, Filling, etc.) <br />Other: — Fee $ <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: <br />Fee <br />$ <br />'So <br />Total Amount Paid to City <br />Fee <br />$ <br />35, SU <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 />fin. \ - I 'a - M <br />Code: White File Copy Canary —Inspector's Copy Pink -Finance Copy Geld Applicant'% Receipt <br />