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GENERAL PERMIT CITY PERMIT NO. 85241 <br />CITY OF ORONO �_l�o_ <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner aYu C' -e r ( C , ` Address <br />Contractor % Address i <br />i <br />City License No. - t1 State 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 S <br />Fee S—____-- <br />Municipal W.tier Connection Fee S — <br />❑Copper n_ <br />Municipal Sewer Connection Fee 5 <br />❑ PVC D Cast n <br />MWCC SAC Charge Fee S <br />On Site Septic System Fee S <br />ACKNOWLEDGEMENT <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 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. AU work shall be <br />done in strict compliance with aU 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 o/ the ronditions of <br />this permit. <br />Sign re of Applit:ant <br />61&n <br />❑ REPAIR <br />titer Well Fee S <br />Mechanical Equipment <br />Fee S <br />Moving /Lifting Buildings <br />Fee S <br />Land Alteration (Excavation, <br />Fee S <br />Grading, Filling, etc.) <br />Fire <br />Fee S <br />rinkler System (Fire) Fee S <br />her:z�T l'.P-in�a-P Fee S J, v j <br />er-the-fact Investigation Fee S J <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee <br />Fee <br />S <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatu of City OfficiaY <br />Code Mile I tic t opy Canary -Inspector's Copy Pink I inance Copy' Cold Applicant's Receipt <br />