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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 ______________ <br />CITY PERMIT NO. . 6769 <br />n.re <br />Contractor,y^'\> <br />Address _ ^ ?c^ fS >C <br />Address ^ /A/ Cr <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____) Fee $________ <br />Meter #______________________ <br />Remote # <br />Municipal Water Connection Fee $. <br />□copper n <br />Municipal Sewer Connection <br />□ PVC □ Cast Q <br />Fee $. <br />MWCC SAC Charge Fee $. <br />J^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 $ <br />Fee $______ <br />Fee $______ <br />Fee $______ <br />Fee $______ <br />Or» <br />Other: <br />After-the-fact Investigation <br />Fee $ <br />Fee $ <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of aU 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 ^all 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^f Applicant ^ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $, <br />Fee $_20^ <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-FUe Copy Canary-Inspector’s Copy Pink-l inance Copy Gold-Applicant's Receipt