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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. 691� <br />Date , � l — b <br />Owner T SSE[ Address �aX 5�' <br />Contractor STeyeta S 1►-)ELL Address MAQCV- i? Al r`S <br />City License No. <br />RI MARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE=. AND FEE <br />❑ NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />Fee $ <br />Municipal Water Connection Fee S <br />❑ Copper ❑ <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast <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 />:{eplrate permit approvals; and that this permit does not <br />giant authority to violate any provision of a.�y 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 />W..enever so ordered, the undersigned agrees to correct <br />any work found to be to violation of the conditions of <br />it's permit. <br />Signar.lre of Applicant <br />State License No. <br />❑ RFPAIR <br />On Site Septic System Fee $ <br />Water Well Fee $ <br />ZO,00 <br />Mechanical Equipment Fee $ <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation, Fee S <br />Grading, Filling, etc.) <br />Other: F:e $ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: Fee $ <br />J � <br />Total Amount Paid to C;ty Fee $alo,_ <br />This permit is not valid until the proper fee is paid _ind <br />it is approved by an authorized City Official. <br />y <br />Code: White —Pik Copy Canary —inspectttr's Copy <br />I•inance Copy Gold Applicant's Receipt <br />