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GENERAL PERMIT CITY PERMIT NO. --s760 <br />CITY OF ORONO_ <br />P.O.BOX 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner �VUlU-E_ (_�PJ AIZIIC=::� Address �S�/<)FS r - <br />Contractor S `�,�-�— Address 4' W y <br />City License No. State Licer­ No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: <NEW ❑ ADDITION <br />Inside Plumbing( # fixtures ) Fee $ <br />Water Meter (Size ) Fee $ <br />Meter # <br />Remote # <br />Municipal Water Connection Fee $ <br />❑ Copper 0 — <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast Q_ <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 of 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. Ali 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 to ordered, the undersigned apses to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />of Applicant <br />k_1 <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Fee <br />Fee $ <br />Fee $ <br />Fee $ <br />Other: Fee $ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: Fee $ <br />Total Amount Paid to City Fee kv ls—1 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signi&(- of City Official <br />Code: White ATe Copy Canary —Inspector's Copy Pink -Finance Copy Gold --Applicant's Receipt <br />