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GENERAL PERMIT CITYYERMITNO. -_—�493 � <br /> � ITY OF ORONO . __� ��� <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> 61?) 47 -7� 57 <br /> 1 ��Owner � � �� Address ��'������ <br /> ('ontra�tor �'�'—�'►'t� Address ����� �-t�'�-� «' � <br /> City License No. State License No. <br /> REMARKS ANll SPECIAL CONDITIONS <br /> YERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plwnbin�; ( �� fixtur�s ) Fee $ On Site Septic System Fee $ <br /> Water Meter (Si�e ) Fee $ Water Well Fee $ �� ' �� <br /> Meter �# <br /> Mechanical Equipment Fee $ <br /> 12emote# <br /> Municipal Water Connection Fee $ Moving/Lifting Buildings Fee $ <br /> �Copper Q Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Municipal Sewcr Com��ction Fee $ <br /> ❑ PVC ❑ C:ast n Other: Fee $ <br /> MWCC SAC Cliargc Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> Tlie undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of all special information, �� <br /> Lercns, conditions or requirements written above. The <br /> undersigned understands and a�ees under penalty of law State Surcharge: Fee � <br /> that this permit is stricUy limited in scope to the work, <br /> activitY or improvement specified; that this Permit does � �� <br /> not �rant 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 /> �ant 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 depaztment regulations, and shall be T�11S p�T7Tllt 1S IIOt valid U11t11 t�lE', pCOpeI' tef', 1S ]�dld i1T11.� <br /> subiect to inspection, approval or reiection bv 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 u� violation of the conditions of <br /> this permit. <br /> Signature of A licant � Sign t re of City Official �� " <br /> � .�..O/�/�,� �—(..�,.-- � � �nV"�,� �J �� �� <br /> Code:White--I ile Copy Canazy-Inspector's Copy Pink-I inance Copy Gold-Applicant's Receipt <br />