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CITY _—?SOZt <br />GENERAL PERMIT <br />CITY OF ORONO /1_/,- ,?q <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />OwnerVe—NayaK_ Address <br />Contractor o k Address <br />zct- <br />City License No. /C; State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPF AND FFE: ❑ NEW ❑ ADDITION ❑ RFPAIR <br />Inside Plumbing( !( Fixtures ) Fee $ I O'i Site Septic System <br />Water Meter (Size__) <br />Meter # <br />Remote M <br />Fee S _ <br />,:;'tticip.! :'A'nG:r Connection Fee S <br />-o.-per ❑ <br />Munii-1,J 5,rwer Connection Fee S <br />❑ PVC ❑ Cast Q___---- <br />MWCC SAC Charge Fee S <br />AC'KNOW LEDCEM ENT <br />The undersigned hereby acknowledges receipt of this Limited <br />permit, including acceptance of all special information, <br />terms, cunditions 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 dies 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 coml'lance with all City ordinances, building <br />codes and/ health department regulations, and shall be <br />sublet, to inspection, approval or rolection by the Citv. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be In violation of the conditions of <br />Oil permit. <br />Signature of Applicant <br />Water W •11 <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (I:xi-avation, <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />101AL <br />State Surcharge: <br />Total Amount Paid to City <br />OF <br />Fee <br />S <br />Fee <br />?n <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S--- <br />Fee <br />S <br />Fee <br />S <br />Fee S �v <br />Fee S <br />This permit is not talid until the proper tee is paid and <br />it is approved by an authori; ed City Official. <br />Sign a of C ity Official <br />Code While I ile Cop) <br />Canary hispe. tor% Cop) <br />Pink I inance Cops Gold Applicant'% Receipt <br />