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CITY PERMIT <br />GENERAL PERMIT <br />CITY OF ORONO Date_ <br />f .O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(61'-))473-7357 <br />Owner Address <br />Contractor Address <br />City License No, <br />REMARKS AND SPECIAL CONDIT IONS <br />PERMIT TYPE AND FEE: ❑ NEW 0 ADDITION <br />Inside Pluml.ing ( # fixtures ) Fee S <br />Water Meter (Sire <br />Meter k _ <br />Remote N . <br />Fee S <br />Municipal Water Connection F _ <br />[hopper a - <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit, utcluding acceptance of all special information, <br />terms, conditions or requirements written abose. The <br />undersigned understands and agrees under penalty of law <br />that this permit Is strictly limited in scope to the work. <br />actitity or improsement specified. that th, permit does <br />not Quit any authority to do work or acU+iues requiring <br />separatepermit approvLls: and that this permit does not <br />grant a-Ithority to vtulate .ny provlslon of anv Citv <br />ordinance or State law, rule or regulation. AU work .+nal] be <br />dune in strict compliance with all City ordinances, building <br />codes andlor health department regulations, and shall be <br />subjectto inspection, approval or relecdon by the Cils. <br />Whenever to ordered. the undersigned agrees to curer, <br />any work found to be in %solation of the conditions of <br />this permit. <br />Signature <br />State License No. <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Ltion (Excavation, <br />Gradin • Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S OP <br />Fee S <br />Fee S <br />State Surcharge: Fee S So <br />Total Amount Paid to City Fee S SSo. 0 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Si t • of City Ofti ' l <br />J <br />Canal)' Inspector'% Copy Pink finance Copy Gold- Applicant's Receipt <br />