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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />CITY PERMIT NO. 6833 1 <br />Date <br />Owner QaLj I -Amg / it Address /2:77 AL FE-eAvD&1=6 <br />Contractor STbDOLA W ELL_ Address MI�� <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />State License No <br />,icey /C •L ► � f� <br />PERMIT TYPE AND FEE. <br />Inside Plumbing ( # fixtures <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />YNEW ❑ ADDITION <br />Fee $ 1 <br />Fee $ <br />Municipal Water Connection Fee $ <br />❑ Copper <br />Municipal Sewer Connection Fee $ _ <br />❑ PVC ❑ Cast Q— <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 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. Ali 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 corre=t <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature of Applic' <br />❑ REPAIR <br />On Site Septic System Fee <br />ee <br />Water Well Fee $ ZQ <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 $ <br />TOTAL <br />State Surcharge: Fee S Sn <br />Sb <br />Total Amount Paid to City Fee $ 2-0 <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 />Code: White -File Copy Canary -Inspector's Copy Pink -Finance Copy Gold --Applicant's Receipt <br />