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GENERAL PERMIT CITYPERMITNO. __—�oii � <br /> CITY OF ORONO , <br /> P.O.BOX 66 Date_�� , � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner �/� Adeir�:ss � ��� ��L1C"� U-t- C9ee <br /> Contractor ��G�� �� Address <br /> City License No. State License No. <br /> RF;MARKS AND SPECIAL CONDITIONS <br /> I'ERMIT TYPE AND FEE: �NEW ❑ ADDITION ❑ REPAIR <br /> lnside Plumbing � # fixtures ) Fee $ On Site Septic System F�e � <br /> �� <br /> Water Meter (Size,� Fee $�L— Water Well Fee $ <br /> Meter # 3e� 10 32�a <br /> ' Mechanical Equipment Fee $ <br /> Re����te# �a � �.-� <br /> a`� Moving/Lifting Buildings Fee $ <br /> Municipa Water Connection Fee $�� s <br /> Copper ❑ Land Alteration (Excavation, Fee � <br /> Grading, Filling, etc.) <br /> Mttnicipal Sewer Connection Fee $ <br /> ❑ PVC ❑ Cast n Other: Fee $ <br /> MJVCC SAC Charge Fee $ After-the-fact Investigation Fee $ <br /> �CJ <br /> ACKNOWLEDGEMENT TOTAL ��•— <br /> The undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of all special information, �� � <br /> ternts, conditions or requirements written above, The <br /> undersigned understands and agrees under penaltY of law State SUr(;11dI�Te: Fet' $ <br /> that this permit is strictly limited in scope to the work, � <br /> activity or irnprovement specified; that this permit does <br /> not grant any authority to do work or activities requiring Total Amount Paid to City FeC � �— <br /> sePazate 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 shall be <br /> done in strict compliance with all City ordinances, building <br /> codes and/or health department regulations, and shall be T�11S iJeIIl71t IS IlOt V311C1 U11t11 tlle pI'Oj�eC fee IS �31C� 8[1C� <br /> subiect to inspection, approval or reiection by the c�cv. it is approved by an authorized City Official. <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 /> Sigriature f Applicant Signature of City ffici <br /> � � � <br /> � <br /> Code:White—Pile Copy Canary—Inspectc�r's Copy Pink—I inance Copy Gold—Applicant's Receipt <br />