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ENERAL PERMIT CITYPERMITNO. g51O1 <br /> �ITY OF ORONO � � ;, J <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> � <br /> ner ' � �e r � ' �-� Address ��� � ���- S �'f �. <br /> � r � (;)f��dies�s�S t ��� . <br /> ,ntractor - <br /> ity License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing (#fi tures_) Fee $ Water Well Fee $ <br /> 7 /� I <br /> Water Meter (Siz Fee � �` u� Mechanical Equipment Fee $ <br /> Meter# �� <br /> Remote# /13 L- �5���� Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ _ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Mwlicipal 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 agrees 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 perxnit does • Cy�� <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ � �� <br /> sepazate permit approvals; and that this pernlit 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 department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection by the c�cy. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to conect <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant Signature of City Of ' 1 <br /> �� ����� <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />