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GENERAL PERMIT CITY PERMIT NO. 8538 <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />01612C <br />Owner Pit Address / C ell �. <br />Contractor Address, IV <br />AJI <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing (#fixtures_) <br />NEW ❑ ADDITION <br />Fee S <br />Water Met,-r (Size) Fee S <br />Metes M <br />Remote <br />Municipal Water Connection Fee S <br />[]Copper <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast Q <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 />er: <br />Fee S IAfter-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 />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. All work shall be <br />done in strict compliance with all Clty ordinances, building <br />codas an <br />health department regulations, and shall be <br />subkct to Inspection, approval or refection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in �iolatlon of the conditions of <br />this permit <br />Signature of Applicant <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <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 />Fee S f <br />Fee S 3�• <br />This hermit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Offi 'al <br />14M <br />Code White- Pile Copy Canary Inspector's Copy Pink -Finance Copy Gold Applicant's Receipt <br />