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CITY Pf RMIT NO.—�6'751 <br />GENERAL PERMIT <br />CITY OF ORONO �- <br />P.O.BOX 66 <br />Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner / �v`" �/'� _ Address <br />Alk- <br />Contractor A& Address <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE: AND FEE: ❑ NEW <br />Inside Plumbing ( # fiiixtures ) <br />Water Meter (Size ) <br />Meter # _ <br />Remote # <br />0 ADDITION <br />Fee $ <br />Fee $ <br />Municipal Eater Connection Fee S <br />❑ Copper <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <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 City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to inspection, 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 conditions of <br />this permit. <br />Signature of <br />State License No. <br />�KRF.PAIR <br />On Site Septic System Fee S O OD <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, etc.) <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee S '50 <br />Total Amount Paid to City Fee S �0. 50 <br />This permit is not valid until the proper fee is paid and <br />it i; approved by an authorized City Official. <br />Sign- r of City Otfial % <br />��m <br />Code. White I ile Copy Canary In,pector's Copy Pink I inane. Cup} Gold Applicant's Receipt <br />