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�'ENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />CITY PERMIT NO. 682 1 <br />Date��� <br />Owner�o�ZL����.,a_..e.:.,_ Address �J�<�5 TL�1flitr2 S <br />Contractor Address <br />City License No. State License No, <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: )(NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />❑ ADDITION <br />Fee $ <br />Fee $ <br />Municipal Water Connection Fee $ <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 Applicant <br />❑ REPAIR <br />On Site Septic System <br />Fee <br />S <br />Water Well <br />Fee <br />$ <br />Mechanical Equipment <br />Fee <br />$ <br />Moving/Lifting Buildings <br />Fee <br />$ _ — <br />Land Alteration (Excavation, <br />Fee <br />$ <br />Grading, Filling, etc.) <br />Other: <br />Fee <br />$ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />sue' <br />State Surcharge: Fee $ <br />Total Amount Paid to City Fee S-0 --! <br />This pennit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Of!`:ial <br />Code White File Copy Canary --Inspector's Copy Pink-I-inance Copy Gold Applicant's Receipt <br />