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GENERAL PERMIT CITYPERMITNO. "r65�I . <br /> CITY OF ORONO , � �_ <br /> r.O.EOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> � <br /> Owner � �� Address � � /���� � <br /> ` /C.�� <br /> Contractor � �[-�--� Address / � ^ <br /> City License No. �f' � ��- State License No. <br /> REMARKS AND PECIAL CONDITIONS <br /> �� 1 <br /> PERMIT TYPE AND FEE: EW ❑ 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: 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 ox 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, � `a <br /> activity or improvement specified; that this permit does J <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ <br /> sepazate permit approvals; and that this pemlit does not <br /> �ant 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 /> �oaes �aior health department regulations, �a �8u be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or rejection by the City. lt 1S 3 roved b an authorized Cit Official. <br /> Whenever so ordered, the undersigned agrees to coxrect pp y y <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Si�� <br /> ature of A�� ican��" Sign r of City Offi 'al �j,�-,� <br /> ` �= ' ,�`)�� � <br /> ��0�� ��'�.�%� ff!�✓C. <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />