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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />to; 11) 471-73i 7 <br />Owner <br />Contras <br />City Li <br />REMARKS AND SPECIAL <br />CITY PERMIT NO. 'MIN <br />Address <br />Address <br />State License No <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing (Mixtures_) <br />Water Meter (Size—) <br />Meter # <br />Remote#) <br />Fee S <br />Fee S __ __ <br />Municipal Water Connection Fee S _ <br />❑Copper F1 <br />Municipal Sewer Connection Fee S -- <br />❑ PVC Cl 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 aeeeptence of all special information. <br />terms, condition or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />that " petntit is strictly limited In Scope to the work. <br />Wdvity air improvement specified: that thle es pot do <br />not gmt any authority to do work or activities requiting <br />$operate permit approval; and that ads permit does not <br />grant authority to violate any provision of any City <br />ordinance or State law. rule or regulation. Ali work .ball be <br />out in strict compliance with all City ordinances. building <br />nodes andlor bealth departmen! regulations. and shall be <br />subject to hnpoetlon, 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 eonditlons of <br />this permit <br />Simature of Applicant <br />ZI,Uff r7a'a, <br />ater Well <br />Mechanical Equipment <br />Moving /Lifting B!iildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire <br />rinkler System (Fire) <br />her: <br />fter-the-fact Investigation <br />TOTAL <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee $ <br />Fee S <br />Fee $ <br />Fee S <br />. _V <br />State Surcharge: Fee S <br />Total Amount Paid to City Fee S <br />This permit is nc valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Si pl of City Officl I <br />Code. White -File Copv Canary - Inspector's Copy Pink -Finance Copy Gold -Applicant's Receipt <br />