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GENERAL PERMI1CITY PERMIT NO. 8523, <br />CITY OF ORONO <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner 1I C C' �C Address 14'A 1 i� <br />Contractor NCB '_.`f ' t IT1 I Address <br />City License No.L)'O'l-1 CJ 11` cl State License No. <br />REMARKS <br />AND SPECIAL CONDITIONS <br />)-) 0 / -- <br />PERMIT TYPE AND FEE <br />Inside Plumbing (#fixtures_) <br />Water Meter (Size—) <br />Meter # <br />Remote # <br />NEW ❑ ADDITION ❑ REPAIR <br />Fee S Water Well <br />Fee S __--_ Mechanical Equipment <br />Municipal Water Connection Fee S —_.— <br />❑Copper n <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge Fee S <br />On Site Septic: System Fee S <br />ing /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire <br />Sprinkler System (Fire) <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee S <br />Fee S <br />ther: Fee S <br />fter-the-fact Investigation Fee S <br />ACKNOWLEDGEMENT I TOTAL <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 />n4ersigned understands and agrees under penalty of law <br />this permit Is stricU• limit*d in scope to We w'Ak, <br />IV or improvement specified: that this permit does <br />not grant any authority to do week or activities re40, r vS <br />separate permit arprovals: and that this permit doe .-A <br />pant authority to violate any provision of any ,..ttr <br />ordinance or State law, rule or •psulation. All work shall be <br />d-ne in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to inspection, aprroval 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 />Signatur • of Applicant <br />State Surcharge: Fee S <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 Official, <br />71 <br />Code White -File Copy <br />Canary Inspector's Copy Pink I inance Copy C II —Applicant's ReMpt <br />