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GEI�TERAL PERMIT CITYPERMITNO. g149 <br /> CITY OF ORONO , _ <br /> P.O.BOX 66 <br /> Date ��' �� � � �� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner ' J I �'� �-''C- � � I S� � Address <br /> fi fj n <br /> Contractor �� Address _ ���t � �� � ��_� (� f� .�"�-� i`-c� . <br /> City License No. � � ��� State License No. �����i����-~���� � <br /> REMARKS AND SPECIAL CONDITIONS <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 $ 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:� ����c � �'c _ 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 /> tertns, 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 ixnprovement sPecified; that this permit does jl/ <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 �aior health department regulations, �a Sn$u be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, anuroval or reiection by the c�cv. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to conect <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant Signa ure of City Official <br /> . �� � ., � _'�.1---- �'� ��� <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />