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GEYERAL PERMIT CITY PERMIT NO. 818� <br />CITY OF ORONO <br />P.O.eOX 66 Datc <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner 1 ► "�_� ti Address ­7.� - 14-k <br />Contractor ) ' C' Address <br />i <br />City License No. �� C' L� State Licensc No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ,;q NEW ❑ ADDITION ❑ REPAIR '' <br />i Inside Plumbing (#fixtures_) <br />Fee <br />S <br />Water Meter (Size_) <br />Fee <br />S <br />Meter# <br />Remote - <br />Municipal Water Connection <br />Fee <br />S <br />❑Copper <br />Municipal Sewer Connection <br />Fee <br />S <br />❑ PVC ❑ Cast <br />MWCC SAC Charge <br />Fee <br />S _ _ <br />On Site Septic System <br />Fee <br />$�l <br />ACKNOWLEDGEMENT <br />E The undersigned hereby acknowledges receipt of this limited <br />permit, Including acceptance of all special Information, <br />terms, conditions or requirements wdtlen 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 requiting <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. AO work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />abject to inapeetion, approval or election by the City. <br />Whenever so orderedthe undersigned agrees to correct <br />i any work found to w In violation of the conditions of <br />this permit. <br />Si ; bf ' •• nt <br />n <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire <br />Sprinkler System (Fire) <br />Dther: <br />After -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S. <br />Fee <br />S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S ��� <br />Fee S S, 2 <br />This pefmit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signatury of City <br />cC,6,' -) <br />r <br />Code: White-- File Copy Canary --Inspector's Copy Pink - Finance Copy Gold -Applicant's Receipt <br />