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GENERAL PERMIT CITYPERMITNO. g452 <br /> CITY OF ORON4 � _ �._ p <br /> P.O.BOX 66 Date � C)� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner Address �� � ��l�C�j �p � -� <br /> Contractor Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> /.��c��- ��x�.�- ���/� 7�7CP(� <br /> PERMIT TYPE AND FEE: �iEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water We11 Fee $ <br /> Water Meter(Size� 3�� Q���� Fee $ / 5` �� <br /> Mechanical Equipment Fee $ <br /> Meter# <br /> Remote�$ � ` 5 Moving /Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $—��- Land Alteration (Excavation, Fee $ <br /> n 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 agrees under penalty of law State Surcharge: Fee $ <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 Total Amount Paid to City Fee $ <br /> separate permit approvals; and that this permit does not ^ �'C,� <br /> grant authority to violate any provision of any City �-Jf� <br /> ordinance or State law,rule or xegulation. All work shall be <br /> done in strict compliance with all City ordinances, building <br /> codes �aior health department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subject to inspection, approval or reiection by the City. lt 1S 3 roved b an authorized Cit Official. <br /> Whenever so ordered, the undersigned agrees to correct pp Y Y <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signat e of Applicant Signature of City Official <br /> . � � <br /> '�/�G `' <br /> Code:White—FIIe Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt <br />