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GENERAL PERMIT CITYPERMITNO. 83'�� <br /> CITY OF ORONO <br /> s � <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner ��� �� ���� ' Address ��(.��� ��--�� �� ��• <br /> Contractor ress <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 /> n Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ _ Fire Fee $ <br /> ❑ PVC ❑Cast Q Sprinkler 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 undersigned hereby acknowledges receipt of this limited <br /> pexmit, including acceptance of all special information, � <br /> terms, conditions or requirements written above. The State Surcharge: Fee .p /� <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 Total Amount Paid to City Fee $ J� <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 �aior health department regulations, �,a sh8u be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection by the c�ty. 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 /> Signature of Applicant Signature of City Offici 1 <br /> � ��. �� �' �m� <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />