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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />4 (612) 473-7357 <br />Owner <br />Cwntractor <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />CITY PERMIT NO. 67215, <br />Date S" y,::1Z <br />Address <br />-Address n <br />PERMIT TYPE: AND FEE: j3J NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ✓ ) Fee $ <br />Water Meter (Size ) Fee $ <br />Meter # _ <br />Remote # <br />Municipal Water Connection Fee S <br />❑ Copper n n <br />Municipal Sewer Connection Fee S <br />❑ PVC [dcast ❑ <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />State License No, <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other: <br />Fee S /v Eff After -the -fact Investigation <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 {rant 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 Citv <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 />an) work found to be in violation of the conditions of <br />this permit. <br />Signature• elf' Applic, fit <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 />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />Fee <br />This pemlit is not valid until the proper fee is paid and I <br />it is approved by an authorized City Official. <br />Sig t it of City Official <br />I <br />4A /11),J <br />Code: White -File Copy Canary Inspector's Copy Pink I inance (y)p) (,old Apphrant'v Receipt <br />