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GENER <br /> AL PERMIT CITYPERMITNO. szs� � <br /> CiTY OF ORONO /�_ ��, <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY,MINNESOTA 55323 � <br /> (612)473-7357 i <br /> Owner �� �dress�� �_1_����� . I <br /> Contractor Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS �� <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑REPAIR I <br /> Inside Plumbing(#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter(Size) Fee $ Mechanical Equipment Fee $ I' <br /> Meter# Moving/Lifting Buildings Fee $ <br /> Remote,# ' <br /> Land Alteration (Exca.vation, Fee $ <br /> Municipal Water Connection Fee $ ,, <br /> � Grading, Filling, etc.) <br /> ❑Copper - <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑Cast � � rinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ ' Other: Fee $ <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The underaigned hereby acknowledgea receipt of this limited <br /> permit, iacluding acceptance of all spedal iaformatton, , <br /> terma, conditions or requirements wsitten aboGe. The <br /> under�igned undexatands and agreea undes penaltY oP ]aw State Surcharge: Fee $_� <br /> that this permit is affict1Y limited in scope to the work, <br /> activity or impzovement speciffed; that thie permit dces ' �� <br /> not �ant anY authorlty to do wark or activitiea reqviring Total Amount Paid to City Fee � <br /> separate permit aPPxovals; and that this permit does not I <br /> grent authoritY to violate anY Provieton oY any CitY � <br /> ordinance ox State law,rule or regulation.AIl work ehall be � <br /> doae ia stdet compltence with all CitY ordinancea,building <br /> codes andlor health deHerta►ent xegulations, and ahall be This permit is not valid until the proper fee is paid and <br /> aub3ect to insHect[on, approvel or re)ectlon by the CitY. it is approved by an authorized CiTy Official. <br /> Whenever so ordezed, the uadezei�ed egreea to coaect <br /> any work found to be in vlolation of the conditioae of <br /> this permit. <br /> Si ature of Applicant Signatu of City Offi ial <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />