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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 />CITY PERMIT NO. 8051 <br />Date <br />Owner 11__ Address ' <br />f n e 'C `_ <br />Contractor Address --S)CIna IU <br />Ppu— <br />City License No. it State License No. <br />REMARKS ANY SPECIAL CONDITIONS <br />AIML. 1 jilt' G"tt-& MCI IV1 Ntic_ <br />A <br />PERMIT TYPE AND FEE <br />Inside Plumbing (#fixtures_) <br />Water Meter (Si/e _ ) <br />Meter# <br />Remote <br />Municipal Water Connection <br />Copper <br />Municip- Sewer Connection <br />❑ NEW ❑ ADDITION ❑ REPAIR <br />Fee S Water Well <br />Fee S -- Mechanical Equipment <br />Moving 'Lifting Buildings <br />Fee S <br />r (Land Alteration (Excavation, <br />_ .� _. _ grading, Filling, etc.) <br />Fee S C- Fire <br />PVC ❑ ('a,t F- Sprinkler System ( Fire ) <br />MWCC SAC Charge Fee S . 4 Other: <br />On Silt: Septic System Fee S After -the -fact Investigation <br />ACKNOWLEDGEMENT <br />The undersigned hereby arknowirdges receipt of Wis limited <br />permit, including acceptance of all special information, <br />term,, conditions or requirements wdlten 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 th..r this permit does not <br />grant authority to vloisle any provieion of any City <br />ordinance or State law, rule or regulation. AU work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations and shall be <br />subiect to Inspection, approval or rejection by the Citv. <br />Whenever so ordered. the undersigned agrees to correct <br />anv work found to be in violation of the condtt.ons of <br />this permit. <br />Signature of Applic,.r.t / <br />TOTAL <br />State Surcharge - <br />Total Amount Paid to City <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee S A 00 1 <br />Fee S _ & CI <br />O I <br />This permit is not valid until the proper fee is paid and I <br />it is approved by an authorized City Official. <br />Si atur bt 0t% OFfic 1 ! <br />1 -'00���1v <br />Code White I ile Cup) (anar% Inq-:tor'% Copy Rnk I inane Cop) cold Appll:ant's Receipt <br />