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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL. BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />CITY PERMIT NO. 7684 <br />Date ,-� - 3G � <br />Owner <br />�` - <br />Address <br />Contractor <br />Address '� . ' <br /><i ��-'i• t <br />>,.%1 CC.d ,� r <br />City License No. <br />�c� <br />X <br />State License No. _ <br />--2L <br />/%A <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing (#fixtures_.) <br />Water Meter (Size �) <br />Meter # <br />Remote'} <br />Municipal Water Connection <br />❑Copper rl <br />Municipal Sewer Connection <br />❑ NEW <br />Fee S <br />Fee S <br />Fee S <br />❑ ADDITION ❑ REPAIR <br />ater Well <br />- (Mechanical Equipment <br />!Lifting Buildings <br />Land Alteration (Excavation <br />Grading. Filling, etc.) <br />Fee S _ e). (.IFire <br />PVC ❑Cast El — Sprinkler System (Fire) <br />MWCC SAC Charge Fee S�_ �- (Other: <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />Fee S (After -the -fart Investigation <br />The undersigned hereby acknowledges receipt of this limited <br />permit, inrludina acceptance of all special information, <br />terms, conditions of 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 don <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 />ordinanre 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 depertment 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 f App 'rant <br />r� i ,c <br />TOTAL <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />J <br />Fee <br />S _- <br />State Surchafgc: Fee SS/ <br />Total Amount Paid to City Fee,� <br />This pemtit is not valid until the proper fee is paid an <br />it is approved by an authorized City Official. <br />Signature of City O icial <br />Code 4ite Idle Copy Canary Inspector's Copp Pink Finance Copy Gold Applicant's Receipt <br />