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GENERAL PERMIT CITY PERMIT NO. — 6602 <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357�Q n <br />Owner i ,kZ3Q�Ue,,0'7 ,L�a,�ft�rs _ Address <br />Contractor & 02jw Address <br />City License No. State License No. <br />REMARKS AN' "PECIAL 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 S <br />Municipal Water Connection Fee $ <br />❑Copper rl <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />G 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 />Fee $ I After -the -fact Investigation <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 />undesirned understands and agrees under penalty of law <br />that " permit is strictly Whited in scope to the work, <br />activity or improvement specifted: 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 %nd/or health department regulations, and shall be <br />sublect 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 />SignatureAf Applicant <br />TOTAL <br />Fee S <br />Fee $ _s:IL.LC <br />Fee $ <br />Fee $ <br />Fee $ <br />Fee S <br />Fee S <br />State Surcharge: Fee S <br />Total Amoun; Paid to City Fee S S� <br />This permit is not valid until the proper fee is paid and <br />it is appr•-)ved by an au.;iorized City Official. <br />Signature of City Official <br />Cude: White -File Copy Canary—Intpector's Copy Pink —Finance Copy Gold- ApplicPn'.'s Receipt <br />