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f' <br />4 <br />GENERAL PERMIT <br />CITY OF ORONO <br />M <br />P.O.BOX 66 <br />CRYSTAL BAY. MINNESOTA 55323 <br />(612)473-7337 <br />CITY PERMIT NO. 7592 I <br />! <br />Date <br />Owner /VIaA^ <br />Contractor OiL^f <br />Address > <br />Address <br />City License No..State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: <br />Inside Plumbing ( # fixtures. <br />Water Meter (Size 1 <br />j^NEW □ ADDITION □ REPAIR <br />)Fee S. <br />Fee $. <br />Meter#, <br />Remote # <br />Municipal Water Connection <br />d Copper n__ <br />Fee S. <br />Municipal Sewer Connection <br />□ PVC □ Cast Q <br />Fee S. <br />MWCC SAC Charge Fee S. <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 5 <br />Fee S______ <br />Fee S______ <br />Fee S______ <br />Fee S______ <br />cjO <br />Other:. <br />After-the-fact Investigation <br />Fee $ <br />Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby scknuwledget receipt of thU limited <br />permit, including gccepUnce 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 Umited 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 SUte law, rule or regulation. All 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 so ordered, the undersigned agrees to correct <br />any work found to be in violation of the condiUons of <br />this permit. <br />Sign,iJlfui^f Applicaiff^ <br />c <br />TOTAL <br />Slate Surcharge: <br />Total Amount Paid to City <br />Fee S.SC» <br />Fee 5 "7^ <br />This pemiit 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 />4^ <br />Code: White I Uc Copy Canary ln%pcci(ir's Copy Pink • I'inancc Cepy Cold Applicant's Receipt