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GENERAL PERMIT CITYPERMITNO. g4�I� <br /> CITY OF ORONO Date � � � <br /> P.O.BOX 66 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner C 1� � Address T��fJ�-� C���`�� f� ' <br /> Contractor w`" �` Address ��`l f1�J� <br /> City License No. 1��� State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> � � -� ' _��/L3 ���� <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 /> � Grading, Filling, etc.) <br /> ❑Copper <br /> �� �(� Fire Fee $ <br /> Municipal Sewer Connection Fee � _�—. <br /> �PVC ❑Cast � Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: Fee $ <br /> O11 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 stricUy limited in scope to the work, <br /> activity or irnprovement specified; that this permit does ��j <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 and/or health depaztment regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subject to inspection, approval or rejection by the c�cy. 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 f icant � Signature of City Of ial <br /> �.'-P-.'L�� c��`_� ��� �a <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />