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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner 111"e'L' <br />i An , /W <br />Contractor <br />City License No. <br />RLMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: kNEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # _ <br />Remote # <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S <br />❑Copper Q <br />Municipal Sewer Connection Fee S_ <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <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 &woes 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 Perinit approvals; and that this permit does not <br />Brant authority to violate any provision of any City <br />ordinance <br />inace or State law, rule or regulation. All work shall be <br />done in strict compliance with all City ordinances, building <br />. odes and/or health department regulations, and shell be <br />abject to inspection, approval or resection 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 />Signature of Ap licant/ <br />CITY PERMIT NO. 7076, <br />JDate t <br />75� AddressAl- <br />Address,( <br />CV ` <br />State License No. <br />❑ 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 />After -the -fart Investigation <br />TOTAL <br />Fee SAS �0 <br />Fee <br />S <br />Fee <br />S <br />r;e <br />S <br />Fee <br />S <br />Fee <br />1 <br />S <br />Fee <br />S I <br />State Surcharge: Fee S �ell <br />Totai Ani uunt Paid to City Fee S —J _S6 <br />This permit is not valid intil the proper fee is pu:.: and <br />it is approved by an aut,..,rized City Official. <br />Sign• i of City Oftici' <br />JNXV <br />S <br />Code: White -Pile Copy Canary Inspector's Copy Pink I inance Copy Gold Applicant's Receipt <br />