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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 />Owner— 411,1jIlta, //,,d <br />Contractor— el�� 111,11 <br />City license No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />❑ ADDITION <br />Fee $_ <br />Fee $ <br />Municipal Water Connection Fee $ <br />❑Copper rl <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast <br />MWCC SAC Charge Fee $ <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information. <br />terns, conditions or requirements written above. The <br />undertgned 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 />gent authority to violate any provision of any City <br />ordinance or State law, rule or regulation. Ali 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 undersigned agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Sign of Applicant <br />�t.� <br />CITY PERMIT NO._ 67591 <br />Date <br />Address C/ / <br />Address �0�4�(7 A� <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 />$ <br />Fee <br />$ <br />Fee <br />S <br />Fee <br />$ <br />State Surcharge: Fee S" <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 />Sign' r of City Official 1 <br />Code: White —file Copy <br />Canary --inspector's Copy <br />Pink —Finance Copy <br />Gold Applicant's Receipt <br />