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GENERAL PERMIT CITYPERMITNO. ���H � <br /> CITY OF ORONO �j �-� <br /> P.O.BOX 66 <br /> Date � ��� 1S -� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> . <br /> Owner `-'" � � �� � Address C� � -� a�� �� <br /> ° �. r •� <br /> Contractor � ����-L� J �1 �� Address l ' <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> /-� _�� ��<- , �5�, <br /> PERMIT TYPE AND FEE: N W ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter (Size_) Fee $ Mechanical Equipment Fee $t �'� <br /> Meter# <br /> Remote# Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ _ <br /> Fire Fee $ <br /> ❑ PVC ❑Cast � 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 /> permit, including acceptance of all special information, ��� <br /> terms, conditions or requirements written above. The <br /> undersigned understands and a�ees under penalty of law State Surcharge: Fee $ ' <br /> that this permit is strictly limited in scope to the work, �� <br /> activity or improvement specified; that this perxnit does / <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ <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 end/or health department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or rejection 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 perxnit. <br /> � <br /> ature of Ap i nt Signat of City Offici �f� <br /> : � C .,`'� d1'��� ' <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />