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GENERAL PERMIT CITYPERMITNO. g4HO � <br /> CITY OF ORONO �- <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner d� ����/��P� Address � � � �� `�� <br /> Contractor �`�� Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> � <br /> ��� <br /> � � S <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDI ION ❑ REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water We11 Fee $ <br /> Water Meter (Size) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# _ Moving �Lifting Buildings Fee $ <br /> M�micipal Water Connection Fee $ _ Land Alteration (Excavation, Fee $ �� '�� <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Mu�licipal Sewer Connection Fee $ _ <br /> 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 �� <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, <br /> activity or improvement specified; that this perxn:t 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 and/or he�ra� department regulations, �a snau be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval ox 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 /> S�i�re Qf�Applicant Signature of City Of�cial <br /> C�CifL.� , ��7�y� <br /> � <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />