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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />CITY PE RMIT NO. “ 70?4 I <br />Date <br />Owner-----rri^^-rna.^ Ad.las. /S <br />Contractor-------___________________/^Vmbj^ Addrcs.s P/d^ Jd • “T <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />State License No. <br />PERMIT TYPE AND FEE: <br />Inside Plumbing ( # fixtures. <br />□ addition D REPAIR <br />) <br />Water Meter (Size^U) <br />I Meic. ~3ai4hU.4X <br />|f Remote# /OC’x^l ^Li liA / <br />Municipal Water Connection Fee $. <br />Fee S________ <br />Fee <br />..opper <br />Municipal Sewer Connection <br />□ pVC GCast Q. <br />MWee SAC Charge <br />Fee S. <br />Fee S. <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 S___ <br />Fee S___ <br />Fee S___ <br />Fee S___ <br />Other:. <br />After-the-fact Investigation <br />Fee S, <br />Fee S, <br />ACKNOWLEDGEMENT <br />Tht undtrtigned hereby ackn jwledgta receipt nt ihii limited <br />permit. Including ecceptence of all Bpecial Information, <br />terms, conditions or requirements written above. The <br />undersigned undersunds and agrees under penalty of law <br />that thU permit U stilcUy Umlud In scope to the work, <br />•ctivlty or Improvement specified; that this permit does <br />not grant any authority to do work or activities requiring <br />aeparau permit approvals; and that this permit does not <br />grant authority to %ioLate any provlaion of any City <br />ordinance or Sute law, rule or regulation AU work be <br />done In strict compliance with all aty ordinances, budding <br />codes and/or health department regulations, aid shall be <br />Mbiect to Inspection, approval or reiectlon by the Oty, <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditiurui of <br />this permit. <br />Signature of Applicant <br />TOTAL <br />State Surcharge: <br />Total Amount I’aid to City <br />Fee S. <br />Fee S.7S^ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatj^of City Official /O <br />Code; Whlie-I U. Copy Canary-Inipeclor’i Copy Pink• I inance Copy <-Ja Appllcanf* Receipt