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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 />Owner-4- ��G- Address _ <br />Contractor !dJ[J'es:4 &a, &!12? Address _ <br />City License No, <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size ) <br />Meter # <br />Remote # <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 pennit 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 andhealth 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 />Signatu ;fAp 'cant j q <br />sor ice' <br />CITY PERMIT NO. s81S <br />Date 0�w, (f0 <br />�e <br />State License No. <br />ro <br />REPAIR <br />On Septic System Fee $ <br />Water Well Fee $ <br />Mechanical Equipment Fee $ <br />Moving,/Lifting Buildings Fee S <br />Land Alteration (Excavation, Fee $ <br />Grading, Filling, etc.) <br />Other: Fee $ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: Fee $ <br />s-0 <br />Total Amount Paid to City Fee <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 />Code: White - Idle Copy Canary - inspector's Copy rink -Finance Copy Gold - Applicant's Receipt <br />