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GENERAL PERMIT CITYPERMITNO. - s2ss � <br /> CITY OF ORONO Date — �c� � �� <br /> r.o.aox 66 <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner � - � Address_ ���� ��(� ��r <br /> .� - <br /> Contractor Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: �' NEW ❑ ADDITION ❑REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter(Size—) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> ❑Copper � Grading,Filling, etc.) <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑Cast n Q� Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ �° Other: Fee $ <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMINT TOTAL <br /> The uadersigned hereby ac3mowledges receipt of this limited <br /> permit, including acceptance of all special infoxmation, <br /> terms, conditions or requirements written above. The <br /> undersi�ned understands and agrees under penalty of law State Surcharge: Fee $ <br /> that this pemiit is atiictlY limited in scope to the wark, <br /> activity or imProvement specified; that thia permit doea ��•� <br /> not graat anY authorlty to do wask or activitiea requlztng Total Amount Paid to City Fee $ <br /> separate permit approvals; and that this peanit doea not � <br /> �ant authorltY to violate anY Psoviaion of any City <br /> ordinance or State law,rule or regulation.AII work aheII be <br /> done in sd3et complience with all CitY ordinances,bwllding <br /> �oaee �aio: he�r� aea�e�t re��o�, �a �an � This permit is not valid until the proper fee is paid and <br /> sub3ect to inaHection, apBroval or xeiectlon bq the City. it is approved by an authorized City Official. <br /> Whanever so ardered, the underai�ed a�eea to correct <br /> any work found to be in violation of the condittons oP <br /> this permit. <br /> Signature of Applicant Signature of City Official <br /> , �,s���-.�/ � <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />