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GENERAL PERMIT CITY PFRMIT NO.--67431 <br />CITY OF ORONO 7 <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner f! �fti �° Address 2cS- <br />Contractor �� /� �� Address r�-{ a- a -- <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # _ <br />Remote # <br />NEW ❑ ADDITION <br />Fee $ <br />Fee $ <br />Municipal Water Connection Fee <br />[]Copper n <br />Municipal Sewer Connection Fee <br />Q PVC ❑ Cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee <br />State License No <br />t <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Al <br />Fee $ <br />Fee $ <br />Fee $ <br />$ <br />Moving/Lifting Buildings Fee <br />Land Alteration (Excavation, Fee <br />�� Grading, Filling, etc.) <br />$� <br />Other: Ft,e <br />$ After -the -fact Investigation 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 work, <br />activity or improvement specified; that this permit does <br />not pant any authority to do work or activities requiring <br />separate permit approvals; and that this permit does not <br />pant authority to violate any provision of any City <br />ormnanee or State law, rule or regulation. All work s:uil 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 epees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Sfi re of Applicant <br />l <br />TOTAL <br />State Surcharge: <br />Total Amount "aid to City <br />Fee $ .156 <br />Fee S ' I <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />SigaLre f City Official <br />Code: White file Copy Canary Inspector's Copy Pink - I finance Copy Gold Applicant's Receipt <br />