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CITY PERMIT NO.” 684§ <br />Date. <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY. MINNESOTA 55323 <br />(612)473-7357 <br />Owner f^^OC.irvA%________ Address <br />Cnntractnr ^?7Q|^jrvOT ^ Address ^2.^^ik\!c AJ/) . <br />City License No._____________________________State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: □ NEW □ ADDITION <br />Inside Plumbing ( § fixtures ___) Fee S_______ <br />Water Meter (Size___) Fee S_______ <br />Meter If____________________ <br />Remote # <br />Municipal Water Connection <br />O Copper D___ <br />Fee S. <br />Municipal Sewer Connection <br />□ PVC □ Cast Q. <br />Fee S. <br />MWCC SAC Charge Fee S. <br />□ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other:_________________ <br />Fee S. <br />Fee S. <br />Fee sJ2D-L. <br />After-the-fact Investigation <br />Fee S. <br />Fee S. <br />Fee S. <br />Fee S. <br />ACKNOWLEDGEMENT <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 agrees under penalty of law <br />that this permit is strictly limited in scope to the work, <br />activity or improvement specified; that this permit does <br />not grant any authority to do work or activities requiring <br />separate 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 />codes and/or health department regulations, and shall be <br />subiect to Inspection, approval or rejection by the City. <br />Whenever so ordered, undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit <br />Signature Aypllcant <br />y'/PU. <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee <br />Fee S_______ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City <br />A <br />Code: White-I'Uc Copy Canary-Inspector ’s Copy Pink-l-inancc Copy Gold-Applicant ’s Receipt