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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. _ 71821 <br />Date l ".21 B 3 <br />Owner Cal /V b T i,t l2 I�y Address _,� 7 ,>/FG&yAPA/ <br />Contractor Address _ SraiIVL lP.A+QK <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: XNEW <br />Inside Plumbing( # fixtures ) <br />Water Meter (Size) <br />Meier # ?,27 <br />Remote# na A <br />❑ ADDITION ❑ REPAIR <br />Fee $ I On Site Septic System <br />Fee $ <br />two <br />Municipal Water Connection Fee S..�_ <br />OCopperlVIL Q <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast rl <br />M JVC( SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned hereby acknowledges receipt of this limited <br />Permit. !ncludknc acceptance of all special Information, <br />terms, conditionb 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 wwk or activntles requiring <br />separate Perm approvals, and that this permit does not <br />grant authority to violate any provisten of any City <br />(wdlnsnce 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 reketlon by the City. <br />Whenecrr so ordered, the ur derafgned agrees to correct <br />any work found to be in y olatlon of the conditions of <br />this permit. <br />gnature �oApplicant <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />Fee S <br />Fee $ <br />Fee S <br />i <br />Fee $ <br />Fee S <br />Fee S <br />Fee $ <br />State Surcharge: Fe;- S <br />so <br />Total Amount Paid to City 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 />Signature of City <br />*�kci <br />Code: White -hale Copy Canary - Inspector's Copy <br />t <br />r <br />Pink -Uinance Copy Gold-Applimt's Receipt <br />