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GENERAL PERMIT CITYYERMITNO. __—�`ZgBI <br /> CITY OF ORONO - <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (61�) 473-7 <br /> Owner �-�U Address l � � /Lt- � � <br /> .-��- �_ <br /> Contractor Address <br /> City I_icense No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> , �� - �, �t��.�_ <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> lnside Plumbing ( # fixtur�s ) Fee $ On Site Septic System Fee $ <br /> Water Meter (Size� ) Fee $�� Water Well Fee $ <br /> Meter �# �� ���� � � <br /> Mechanical Equipment Fee $ <br /> Kemote# <br /> Municipal Water Conn�ction Fee $ Moving�Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Municipal Sewer Conn�ction Fee $ <br /> ❑ PVC ❑ Cast n Otlier: Fee $ <br /> MWCC SAC Charge Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of all specia] 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, �,r- <br /> activity or improvement specified; that this permit does J <br /> not grant any authority to do work or activities requiring Total Amount Paid to City F0e � <br /> sepazate permit approvals; and that this permit does not <br /> grflnt 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 TY11S pe277l1t 1S 110t Vd11C� Ulltll tlle pl'OpeI' tf'e iS pd1C� i1RCl <br /> subiect to inspection, approval or reiecuon by the c�cy. it is approved by an authorized City Official. <br /> Whenever so oxdered, the undersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant Signature of City O �c� 1 <br /> �� �.��y i-. .� <br /> _� <br /> Code:White—I ile Copy Canary—Inspector's Copy Pink—I�inance Copy Gold—Applicant's Receipt <br />