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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 PF.RMIT NO. 7126 , <br />Date 3C — 3 <br />Owner, hlixizZ0 1 L1 J�e�SC�� Q,�;t,� _ \ Cj`^C-.5%ddress _ 7&00 3Ajc=-VAe— <br />Contrartor�l � _---_--------- Address <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FI::E:: <br />Inside Plumbing ( # fixtures <br />�NEW ❑ ADDITION <br />Fee $ <br />Water Meter (Size ) Fee $ <br />Meter # _ <br />Remote # <br />Municipal Water Connection Fee S <br />❑Copper <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ cast 0-_ <br />MWCCSAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned hereby acknowledges receipt of this limited <br />permit. Including acceptance of all special information, <br />terms, cor.ditions or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />the# ::ds 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 />subJect to Inspection, approval or relectlon by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature of Applicant <br />T <br />❑ REPAIR <br />On Site Septic System Fee S <br />Water Well Fee S <br />Mechanical Equipment Fee $ <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation, Fee S <br />Grading. Filling, etc.) <br />Other: Fee S <br />After -the -fact Investigation Fee $ <br />ZU 10 O <br />.TOTAL <br />State Surcharge: Fee 5 <br />Total Amount Paid to City Fee $ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatt of city Of <br />Code: %'hile — mile Copy Canary --Inspector's Coay Oink -Finance Copy Gold AppliLant's Receipt <br />