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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 / I �i !v ! . -1 <br />Contractor 1, ' <br />City License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing (#fixtures_) Fee S <br />Water Meter (Site Fee S <br />Meter # - ''G ,,� L" / <br />Remotr'(__ <br />Municipal Water Connection Fee S <br />❑Copper ❑ <br />• <br />Municipal Sewer Connection Fee S _ . <br />❑ PVC ❑ Cast F_ <br />MW(V SAC Charge Fee S <br />On Site Septic System <br />ACKNOWLEDGEMENT <br />CITY PERMIT NO. 8541 <br />Date _ 2( <br />t l <br />Address �_' r � � (,• ►. ' <br />1' <br />Address y �Yl h Y h <br />State License No. <br />❑ REPAIR <br />Water Well <br />Mechanical Equipment <br />Moving Lifting Buildings <br />Land Alteration (Excavation, <br />Grading. Filling, etc.) <br />Fee S <br />Fee S <br />Fee S__ <br />Fee S <br />ire Fee S ' <br />nkler System (Fire) <br />Fee S <br />her: Fee S <br />Fee 5 IAfter-the-fact Investigation Fee S __ I <br />The undersigned hereby acknowledges receipt of this limited <br />permit. including acceptance of W special Information, <br />terms, conditions or requirements written above. The <br />undersigned understands and sown under penalty of law <br />that " permit is strictly United 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 />s "Pate permit approvals; and that this permit don not <br />Xt authority to violate any provision of soy City <br />ortAnance or State law, rule or regulation. Ati work shall be <br />!tme in strict compliance with fill City ordinances, building <br />cod" and/or health department regulations, and shall be <br />subject to u;:pection, approval or refection by the City. <br />Whenever so ordered. the undersigned agrees to correct <br />any worth found to be in lolation of the conditions of <br />this permit. <br />Signature ' pplicant ' <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S _ / <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatury of City Off ial <br />Code While I de ( ups <br />Canar> Inspector's Cop) <br />Pink I inancc Cop) , / Gold Applicant's Receipt <br />