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GENERAL PERMIT CITY PERMITNO._-704$1 <br />CITY OF ORONO G-2y-lg <br />f .O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-773�57 <br />Owner S�L/'��'�_D ( "'Vs '. Address 3 7 7d C—Aly - <br />Contractor DN / er Address ME*A AV—� m k <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE. AND FEE: XNEW <br />lnside Plumbing ( Al fixtures ) <br />Water Meter (Size—) <br />Meter <br />Remote N <br />❑ ADDITION <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S <br />❑Copper <br />Municipal Sewer Connection Fee S <br />❑ PVC' ❑ Cast ❑ <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit. Incluutng acceptance of all special Information, <br />terms. conditions or iequiremenU written above. The <br />undersigned understands and agrees under penally 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 activi:les 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, r 'e w regulatlon. Ali work shall be <br />done In strict compliance with ail City ordinances, building <br />codes and/or health department regulations, and shall be. <br />subject to Inspection, approval or r0ectlon bs the City. <br />Whenever sc ..rdered, the undersigned agrees to correct <br />any work found to be in violation or the conditions of <br />thla permit. <br />Signature of Applicant <br />State Licenu No. <br />❑ REPAIR <br />On Site Septic System Fee S <br />Water Well Fee S <br />Mechanical Equipment Fee S <br />Moving/Lifting Buildings Fee S <br />Land Alteration (Excavation, Fee S <br />Grading, Filling, OV, ) <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTA <br />State Surcharge: Fee S CID <br />Total Amount Paid to City Fe. S <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Sign at of City Offic I <br />C It, white—l-ot Copy Canary Inspecti-r's Copy Pink I inance Cop) Gold Applicant's Receipt <br />