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GENERAL PERMIT CITYPERMITNO. �99� � <br /> CITY OF ORONO Date .�- /� i- ���' <br /> P.O.BOX 66 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> �`��i� � �L �� �` %�r C> � c�X �--._ <br /> Owner /"l/�t�- Address �?` <br /> Contractor <�� '�"��� �1/ "� Address ' � f� �1 �t)�' � - i�� <br /> ,--� <br /> City License No. /' �`� State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: '�J 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 $ Fire Fee $ <br /> ❑ PVC ❑Cast n 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 Q <br /> undersigned understands and a�ees under penalty of law State Surcharge: Fee ,p <br /> that this permit is strictly limited in scope to the work, <br /> activity or improvement specified; that this permit does �C'' ��� <br /> not grant any authority to do work or activities requiring Total Amount Paid to City F28 $��1 <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 /> �oaes and/or ne�tn department regulations, �a sheu be This permit is not valid until the proper fee is paid and <br /> subject to inspection, approval or reiection by cne 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 /> Signatur�p f,Appl'cant Signature of City Official <br /> ��4,,�'�� ,�-� 1_/�'�' � `- , ,.- �� � C�c�- _ _� ��� <br /> b - <br /> i <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance� y Gold—Applicant's Receipt <br />