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CITY PtRMITNO.--s"%`�,�� <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 Date G <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner i ll/ �ddress <br />Contractor 1 �d Address <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: *NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # _ <br />Remote # <br />❑ ADDITION <br />Fee $ <br />Fee $ <br />Municipal Water Connection Fee S <br />❑Copper n <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 />Municipal Sewer ction Fee $ •L- <br />❑ PVC Co]`Cast ❑ Other: <br />MWCC SAC Charge Fee After -the -fact Investigation <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of at: special information, <br />terms, conditions or requirements wdtten above. The <br />undersigned understands and agrees under penalty of taw <br />that this permit is strictly limited in scope to We 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 />Want authority to violate any provision of any City <br />ordinance or State law, rule or regulation. All work shall be <br />done to 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 />Signature of pplicant <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S <br />Fee $ — <br />Fee $ — <br />Fee $ <br />Fee $ <br />Fee $ _ <br />Fee $ <br />Fee $ <br />This pennit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Si Official <br />") ;;") //,l <br />Code White file Copy Canary -inspector's Copy <br />Pink —Finance Copy Gold Applicant's Receipt <br />