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GENERAL PERMIT CITYPERMITNO. "�622 � <br /> CITY OF ORONO _ <br /> P.O.BOX 66 Date +� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner � ��� /�-l._� / �`7` � - �(1:�� � <br /> Address <br /> Contractor �_�C�tJ-�f")S 11�! Address � � — � l� <br /> City License No. � /� � State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: �NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water Well Fee $�_�'-'�..5�� <br /> Water Meter (Size) Fee � Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ _ _ <br /> Fire Fee $ <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 /> ACKNOWLEDGEMENT TOTAL <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 a�ees under penalty of law State Surcharge: Fee $ <br /> that this permit is strictly limited in scope to the work, . � <br /> activity or irnprovement specified; that this perxnit does <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ <br /> sepazate 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 shall be <br /> done in strict compliance with all City ordinances, building <br /> codes �a�or health department regulations, �a sheu be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection by the c�cY. it is approved by an authorized City Official. <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 /> . <br /> Signature of Appl�a � , Si t re of City Offi ' � <br /> / ���, �.-�.d,� � <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />