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CITY PERMIT NO. 67g�! <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOx 66 Date <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />Owner 422V�ee.-,, Address /._XJJ /`' ,e <br />Contractor — Address <br />City License No. State 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 S <br />Municipal Water Connection Fee $ <br />❑ Copper ❑ <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast ❑ <br />MWCC SAC Charge Fee J op <br />ACKNOWLEDGEMENT <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 etiolate any provision of any City <br />ordinance or State law, rule ar regulation. All work shall be <br />done In strict compliance with all City ordinances, building <br />codes and/or hearth department regulations, and shall be <br />subject to inspection, approval or rejection by the Citv. <br />Whenever ao 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 />C <br />❑ REPAIR <br />On Site Septic System Fee <br />Water Well Fee $ <br />Mechanical Equipment Fee $ <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation, Fee $ <br />Grading, Filling, etc.) <br />Other: Fee $ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: Fee S <br />Total Amount Paid to City Fee S <br />i� <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official <br />Sig i r of City Offi ial <br />JJ .i <br />Code: White File ( upy Canary -Inspector's Copy Pink Finance ( opy Gold —Applicant's Receipt <br />