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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)) 4733-7357 <br />Owner "ii&o <br />Contractor &,kl j <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: [NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size ) Fee $ <br />Meter # <br />Remote # <br />Municipal Water Connection Fee $ <br />❑Copper a <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast n <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 ahaL be <br />done in aWct compliance with all City ordinances, building <br />codes and/or health department regulations, and stall be <br />abject to inspection, approval or -election 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 A plicant <br />CITY PERMIT NO. 66711 <br />� r <br />� . Z,� i -N, � � <br />Address S V lee� <br />Address <br />State I i-ense 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 />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Other: Fee S <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $ <br />Fee $ OtiJ . �l C1 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. , <br />Jit^' 1�e of City �)t�lllal�1 �1 <br />Code. White -I He Copy Canary- Inspector's Copy Pink -I inance Copy Gold -Applicant's Receipt <br />