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GENERAL PERMIT CITY PERMIT NO. 8487- <br />CITY OF ORONO g <br />Date <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner ✓ Address <br />Contractor O GL W-ell Address <br />City License No. ! State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Flum} ing (#fixtures_) <br />0 NEW ❑ ADDITION <br />Fee S <br />Water Meter (Size_) Fee S <br />Meter# <br />Remote # <br />Municipal Water Connection Fee S <br />❑ Copper r l --- <br />Municipal Sewer Connection Fee S _-- <br />❑ Pv( ❑ Cast D <br />MWCC SAC Charge Fee S <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire <br />Sprinkler System (Fire) <br />- (Other: <br />Fee S lAfter-the-fact Investigation <br />The undersigned hereby acknowledges receipt of this limited <br />permit. Including acceptance of W 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 Rant any authority to do work o, ctivities requiring <br />saparate permit approvals; and that No n rmit does not <br />Rant authority to violate any pro n of any City <br />xdinanee 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 dcpartmonl 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 />Signature of Applic ant_ <br />TOTAL <br />Fee S 1- 3v.67) <br />Fee S <br />Fee S <br />Fee S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />State Surcharge: Fee S <br />Total Amount Paid to City Fee S 3o. -LZ�jl <br />This permit is not valid until the proper fee is paid and <br />it is approved by do authorized City Off. al. <br />Signature of City Official <br />Colr, Whitc File Copy Canar) - Inspector's Copy Pink - Finance Copy Gold —Applicant's Receipt <br />