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GENERAL PERMIT <br />CITY OF ORONO <br />CITY PERMIT NO. <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Date, <br />8029 <br />K^- SS' <br />t <br />Owner lien Address <br />Contractor 0(1 H oi^ S / I Address /^ (io H U/j/f T "j'lC^CKJ <br />l(o^_________ ‘City License No..State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: <br />Inside Plumbing (#fixtures__) <br />^NEW □ ADDITION □ REPAIR <br />Water Meter (Size__) <br />Meter#_______ <br />Fee S <br />Fee S <br />Remote #. <br />Municipal Water Connection <br />QCopper rn <br />Fee $ <br />Municipal Sewer Connection <br />□ pVC Dcasl Q <br />MWCC SAC Charge <br />On Site Septic System <br />Fee S <br />Fee $ <br />Fee S. <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee <br />Fee $________ <br />Fee $_________ <br />Fee $_________\ <br />Fire <br />Sprinkler System (Fire) <br />Other:______________ <br />After-the-fact Investigation <br />Fee $. <br />Fee $. <br />Fee $ <br />Fee S. <br />i. <br />ACKNOWLEDGEMENT <br />The undentgiteil haraby Mkoowladges ncelpt of thla limited <br />pennlt. including ecceptenc* of all ipecial Infonnatton. <br />terais, condfttoni or icquiremcnte written above. The <br />undeirigned undantendi and acreea under penalty of law <br />that thla permit is strictly limitec* in scope to the work, <br />activity or improvement dpeclfled: 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. rtUe or regulation. AO work khall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to Infection, epproval 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 gj^pplicant <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $, <br />Fee i <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 Official <br />TrIYn <br />Code: White-nie Copy Canary-Inspector's Copy Pink-Finance Copy Gold-Applicant’s Receipt