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GENERAL PERMIT CITY PERMIT NO. --71U <br />CITY OF ORONO v2 <br />P -0 -BOX 66 Date t� -- J J <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-73 <br />Owner �^ I_.l Address / 46 1 i/Oaf <br />Contractor /n.( L._ ( Address <br />City Licenar No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPF AND FEE: ❑ NEW ADDITION <br />Inside Plumbing ( N fixtures_) Fee S <br />Water Meter (Size_) Fee S <br />Meter M <br />Remole N <br />Municipal Water Connection Fee S <br />❑Copper ❑ <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast n_ <br />MWCC SAC Charge Fee 5 <br />ACKNOWLEDGEMENT <br />The undantaned hanby Tran owledMa rettlDl of this limitedpermit, lncludbg eccep{arce of til pedal Inlorrnstlon, <br />terms, conditions o@ n•uinmenta scittt- above. The <br />underaged und@ntsnds and aspoes under penalty of raw <br />that thispared/ bi sbledy timlted in scope to the wort, <br />ac deity cr I-Prpvewent peeir d; that tbh permit does <br />and grant any wthosity to do work M actlNM <br />tles n•ung <br />sava"LP Permit approval; and that this permit does not <br />Qant aulhoAty to Mdata any Oeovleionof any City <br />ordinance or Stat" law. rule nr tsgulatloo. Alf work thea be <br />it in 'sties eosaµLanea with all City ordinances. building <br />cod's and/or health dspatt+n'nt regulations. and shelf be <br />subitcl to inepectlon, approval ne relectlon by the City. <br />Whenever 8" <br />ordrd <br />ered, the undagned sgrees to comet <br />any .-k found to be N .solation of the conditions of <br />this permit. <br />Signa''ttu/u of Appficant� <br />Code White I do Copy Canary Innpec air's Copy <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteratio-i (Excavation <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />Slate Surcharge: <br />Total Amount Paid to City <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee S <br />Fee S <br />Fee S�LJ <br />Fee S—IiQ-0 <br />This permit is riot valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />• <br />Sig f City Official <br />Pink 1 inance Cop) Gold Applicant's Receipt <br />