Laserfiche WebLink
GENERAL PERMIT <br />CITY OF ORONO <br />■U. <br />CITY PERMIT NO.7004 <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Date, <br />Owner T)/lUIi4 <br />Contractor <br />City License No._________________ <br />Address. <br />Address <br />3l7S <br />C-lnAiU A/ft^ <br />State License No. <br />ri:marks and special conditions <br />^vctcq-/ <br />PERMIT TYPE AND FEE: <br />Inside Plumbing ( # fixtures. <br />Water Meter (Size____) <br />Meter #__________ <br />□ NEW □ ADDITION <br />_) Fee $________ <br />Fee $________ <br />Remote # <br />Municipal Water Connection <br />Q Copper ri <br />Fee $. <br />Municipal Sewer Connection <br />□ pVC DCast Q <br />Fee $. <br />MWCC SAC Charge Fee $. <br />□ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Fee $. <br />Fee $. <br />Fee $. <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee $ go <br />Fee $-------------- <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 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 anv City <br />ordinance or State law, rxUe or regulation. All work shall be <br />done in strict compliance with all City ordinances, 'a-..Uding <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 />Signatu of p a <br />A // <br />/I <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee $ <br />Fee S fiO » <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 />Signature of City Official <br />Code: White-File Copy Canary - Inspector’s Copy Pink- I'inance Copy Cold-Applicant’s Receipt <br />BS i