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GENERAL PERMIT <br />CITY OF ORONO <br />KCI -BOX 66 <br />c RYSTAL BAY, MINNESOTA 55323 <br />(61 2) 473-7357 <br />CITY PI• RMIT NO. 7085 <br />I1.Itt• -� <br />S1Dt <br />Contractor JAAddress <br />Address <br />City License No. ---- -- <br />State License No. <br />RI MARES AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW <br />Inside Plumbing ( # fixtures__, ) <br />Wa ter Me ter (Size) <br />❑ ADDITION <br />Fee $ <br />Fee S <br />Meter # <br />Remote # <br />Municlpal Hater C'unnectioll l:ee S <br />❑('Upper Q <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast <br />MWCC SAC Charge Fee S I <br />ACKNOWLEDGEMENT <br />The undersigned herrb>acknowledges receipt of this limited <br />Permit, including acceptance of all sDrclal Information, <br />terms, conditionsor requirements written above, The <br />undersigned understands and agrees under penalty of law <br />that this permit is strictly limited In scope to the work• <br />activitY or impreVement speclfled; that this permit does <br />not grant any authority to do work or acuvitles requiring <br />separate permit approvals; and that this permit does not <br />grant authorityto vyulate any Dructialun of any <br />ordinance or State laM, rule <br />dune in strict compliance w regulation. All work shall be <br />codeswith ail Oil ordinances, building <br />sub/eet and/or health department regulations• and shall be <br />M inspection, approval or re►ecuon by the C11s <br />Whenrcrr so ordered, the undersigned agrres to corrrcl <br />any work fond to be to %101"on of <br />this Permit. the cun•IiUun► of <br />Signatu of Applifan I <br />Code: White -1-1k Copy Canary-InVftitur's copy <br />XRFPAIR <br />On Site Septic: System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Fee <br />Fee -- <br />Fee S <br />Fee S <br />Other: <br />Fee S <br />After -the -fart Investigabun Fee S <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S SU <br />Fee S 20 r° <br />This permit is nut valid until the proper fee is paid and <br />it is approved by all authorized City Official. <br />Sign re of ' ty Official <br />Pink- I inantx Copy Gold Applicant's Receipt <br />