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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL, BtkY, MINNESOTA 55323 <br />(612) 473-7357 <br />CITY PERMIT NO. 70261 <br />Datc_�-Io — b� <br />Owner :;2a gS E Address _ I d 6o FOx_ S f <br />od <br />Contras for SroDo LAS SE L _ Address _L44-TK4 <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: O(NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # _ <br />Remote # <br />❑ ADDITION <br />Fee $ <br />Fee S. <br />Municipal Water Connection Fee $ <br />❑ Copper ❑ <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast [1 <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <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 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. 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 />any work found to be In violation of the conditions of <br />thii permit. <br />Signature of Applicant <br />C.l 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 />After -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />00 <br />Fee S '76 <br />Fee $ <br />Fee S <br />Fee S <br />FeL $ <br />Fee $ <br />.20 0-0 <br />Fee S - `s® <br />Fee $ 2-0' <br />This pennit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatu 'ity <br />Code White - File Copy Canary Inspector's Copy Pink I inance Copy Gold Applicant's Receipt <br />