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GENERAL PERMIT <br />CITY OF OftONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner .� /laGr �fi�uea� t d-. <br />Contractor <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />-.41-7 <br />PERMIT TYPE AND FEE: X <br />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 ❑ <br />Munici al Sewer Connection Fee <br />PVC ❑ Cast [1 <br />MWCC S C Charge Fee $ <br />ACKNOWLEDGEMENT <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 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 to ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature ant <br />Code: White —File Copy Canary --Inspector'& Copy <br />CITY PERMIT NO. 6854, <br />Date fa - aw/_ 910 <br />Address <br />Address r� Z?11 <br />State License No. I% 124 <br />Cl 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 $ <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 />Fee S <br />si0 <br />Fee fJ <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 City ffj <br />Pink --Hnance Copy Gold Applicant's Receipt <br />