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GENERAL PERMIT CITY PERMIT NO. 8187 <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 ^ <br />Owner C;t.l' yl I ti Address ✓�[L'�� l n�LL fiC'/ �• <br />Contractor f 1 Address <br />City License No c (C.' I State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: *NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing Ofixtures_) <br />Water Meter (Size_) <br />Meter# <br />Remote 1 <br />Municipal Water Connection <br />❑Copper 11 <br />Municipal Sewer Connection. <br />Fee S <br />Water Well <br />Fee S <br />Fee S —__- _ <br />Mechanical Equipment <br />Fee $ <br />Moving /Lifting Buildings <br />Fee S <br />Fee S _ <br />Land Alteration (Excavation, <br />Fee $ <br />Grading, Filling, etc.) <br />Fee S _ Ir ire Fee S <br />❑ PVC ❑ Cast a <br />MWCC SAC Charge Fee S <br />On Site Septic System Fee S 100 <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special Information, <br />terms, con.litlons or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />that this pe.mlt is strictly limited In scope to the work, <br />activity or unprovement 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. Ail work shell be <br />done In strict compliance with all City ordinances, building <br />codes end/or health department regulations, and shall be <br />subject to inspection, approval or rslection 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 />ature of <br />)rinkler System (Fire) <br />ther: <br />fter-the-fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S j <br />Fee $ I <br />Fee S ' -3 <br />Fee s' �, <o <br />This permit is not valid until the proper fee is paid and I <br />it is approved by an authorized City Official. <br />4 <br />Signature of ty Official <br />r LLx w, <br />Code. White file Copp Canary - -Inspector's Copy Pink --Finance Copy Gold -Applicant's Receipt <br />