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. GEN�RAL PERMIT CITYPERMITNO. 853'7 � <br /> CITY OF ORONO _�� _ <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner Address l ��� U�'d ��J7 �� ' <br /> Contractor n� Address���CC1�� d ,�� a� I <br /> City License No. � � State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> ��C � �� s � �� � '� <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑REPAIR <br /> Inside Plumbing(#fixtures_) Fee $ Water Well Fee $.�— <br /> Water Meter(Size) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote�$ Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ <br /> Land Alteration (Excavation, Fee $ <br /> ❑Copper ❑ Grading,Filling, etc.) � <br /> ire Fee $ <br /> Municipal Sewer Connection Fee $ I <br /> �PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: Fee $ <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ '� <br /> , <br /> ACKNOWLEDGEMENT TOTAL <br /> The undexsigned hereby acknowledgea receipt of thie limited <br /> permit, including acceptence of ell epedal iaPozmation, } � <br /> terms, conditiona or xequirements wsitten above. The State Surcharge: Fee $ <br /> uadersigned underatands and agees uader penelty oY law <br /> that this pemiit is strictly lixnited ia scope to the work, ' <br /> activitq or 9mprovement speci�ed: that t�is permit doea P� <br /> not grant anY authorlty to do wark or activittes requ9ring Total Amount Paid to City Fee ��` <br /> separate permit approvals; aad that this pemiit does aot � <br /> graat authority to violete any provis[on of any City �i <br /> ordinance or State law,rule or regulation.All work ahall be <br /> done ia strlct complisnce with aII CitY ordiaancae,bwllding <br /> codes and/or health department reGulatlons, end ehall be 'This permit is not valid until the proper fee is paid' fl11Ci <br /> sub9ect to inaPectioa, apHroval or reiection by the City, it is approved by an authorized City Official. ' <br /> Whenever eo ordered, the undersigned egreea to correct <br /> any work found to be in vtolat3on of the conditlona oP <br /> this Permit. <br /> Signatur of Applicant Signa of City Official <br /> � �' <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Go d—AppHcant's Receipt <br />