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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 />� <br />Owner • 41 /j�tl,12 i-A C� <br />Contractor ,f�� !2 Z-ce 6- <br />0 <br />CITY PERMIT NO. 6669 ' <br />Date <br />Address <br />Address 44 mil <br />City License No. �% State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE. AND FETE: NEW <br />Inside Plumbing( # fixtures-) <br />Water Meter (Size ) <br />Meter # _ <br />Rsmote # <br />SA(- -#E�6- 3 <br />❑ ADDITION ❑ REPAIR <br />Fee $ 1 On Site Septic System <br />Fee $ 1 Water Well <br />Municipal Water Connection Fee $ <br />❑Copper <br />Municipal Sewer Connection Fee $_ <br />XPVC ❑ Cast n <br />MWCC SAC Charge Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />terms, conditions or requirements wdtten above. The <br />undersigned understands and agrees under penalty of law <br />that this permit is strictly limited in scope to the work, <br />activity or improvement specified; that this permit does <br />not grant any authority to do work or activities requiting <br />separate permit approvals; and that this permit does not <br />grant authority to violate any provision of any City <br />ordinance or State law, rule or regulation. All work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to Inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Si OnateIoAp ica t <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />L nd Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />S <br />Fee <br />$ <br />S �'f <br />Fee S <br />Fee S �2c' l <br />This permit is nit valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City O <br />Code White I de Copy Canary Inspector's Copy <br />Pink - I inance Cop> Gold Applicant's Receipt <br />