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GENERAL PERMIT CITYPERMITNO. g55� ' <br /> CITY OF ORONO <br /> P.O.BOX 66 Date --, �-t �-"7 _�r� � �o <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> �� <br /> Owner � 0 �J � �N�-- Address 2 �' � C. G������ <br /> Contractor ��.ti/�'"��L-- Address S�� <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> � rE�Z , iJr�C��' �{-- � �,C�� s <br /> �'G ���'�V� <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 $ _ <br /> 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 /> � <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 Q .r— �2"� <br /> undersigned understands and agrees under penalty of law State Surcharge: Fee .p <br /> that this permit is strictly limited in scope to the work, S� <br /> activitY or unProvement specified; that this permit 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 /> �oaes �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 ,r Signature of ' Of cial <br /> � ,y <br /> �/ <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt <br />