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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 PERMIT NO. 695a <br />Date 2-- 2 Z - 13 <br />Owner Lbe,44 1 <br />- - _- Address <br />✓��J <br />C.IQ(,/:5T4 <br />t <br />1pz.4e e— <br />Contractor <br />Address <br />JO o UilCY <br />n <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size1L) Fee $ <br />Meter # "++�vter�� •�C�S�/� <br />Remote # 139 r3 <br />00 <br />Municipal Water Connection fee $_ <br />❑ Copper n <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <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 wark, <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 provisinn of any City <br />ordinance or State law, rule or regulation. dill 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 rejection by the City. <br />Whenever so ordered, the undersi;ned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signa of pplic• nt <br />State License No. <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 />After -the -fact Investigation <br />TOTAL <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />$ <br />Fee <br />c <br />7S7.00 <br />State Surcharge: Fee S <br />Total Amount Paid to City Fee Ste__ <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Sign <br />Code: White -File Copy Canary - Inspector's Copy Pink- I finance Copy Gold -Applicant's Receipt <br />