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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOx 6o <br />CRYSTAL BAY, MINNESOTA 55323 <br />61' 473 7'I57 <br />CITY PFRMIT NO. 7259 1 <br />Date 1 2 - s 43 <br />1 _) - <br />Owner T)"A Qo!-,Kf�_— Address Ammss j-_ <br />Contractor-STphkp `%Ewey- i Address P3 1 Y\CA Minn <br />City license No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE: AND FI:E: A61 F W <br />Inside Plumbing # fixtures ) <br />Water Meter (Site ) <br />Meter k <br />Remote # <br />❑ ADDITION <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S <br />❑Copper Q_ <br />ry <br />Municipal Sew-e:r Connection Fee S <br />XPVC ❑ ('as[ a <br />MWCCSAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <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 Use nark. <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 />grant authority to violate any provision of any City <br />ordinance or State law, rule or regulation. Ali work allied be <br />done in strict compliance with as City ordinances, building <br />codes and/or health department regulations, and shall be <br />sub)ect to Inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />an) work found to oe its violation of the conditions of <br />this permit. <br />Signature ' pplicant ,. <br />State License No <br />❑ REPAIR <br />On Site Septic System Fee S <br />Water Well Fee S <br />Mechanical Equipment Fee S <br />Moving/Lifting Buildings Fee S <br />Land Alteration (Excavation, Fee S <br />Grading, Filling, etc.) <br />Other: Fee S <br />After -the -fact Investigation fee S <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />20, <br />Fee S So <br />Fee S 20 - <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of ('ity Official <br />Code. White I Ile ( opy Canary lnspector's Copy Pink I inance Copy Gold Applicant's Receipt <br />