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GENERAL PERMIT CITYPERMITNO. —_—�OOo � <br /> CITY OF ORONO � <br /> P.O.BOX 66 Date � — � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Ow�ier � I��F2�'t-- _ � Ad�ress ���� ���n�D� �. <br /> Contractor�����5. C�rvs i Address /�/' <br /> Ci[y License No. State License No. <br /> RF,MARKS AND SPECIAL CONDITIONS <br /> PF,RMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR <br /> lnside Plumbing � # fixtures ) Fee $ � On Site Septic System Fee $ <br /> �i � �pC.� <br /> Water Meter (Size�) Fee $,_L.r.�L— Water Well Fee $ <br /> Meter # ��g���y+ <br /> Mechanical Equipment Fee $ <br /> Remote# _,'3d I[�327�i <br /> Municipal Water Connection Fee $_,_ Moving/Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Mtinicipal Sewer Coniiection Fee $ <br /> ❑ PVC ❑ Cast ❑ Other: Fee � <br /> M'vVCC SAC Charge Fee $ After-the-fact Investigation Fee $ <br /> �,5� <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of all special 'vlformation, <br /> terms, conditions or requirements written above. The <br /> undersigned understands and agrees under penalty of law StatC SUICrldi�e: Fet; � <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 TOt3� f�1170Ut1t �ill(� t0 Clty Fee $ <br /> sepazate perxnit approvals; and that this permit does noL <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 complience with all City ordinances, buIIding <br /> codes and/or health department regulations, and shall be T111S peTlTllt IS riOt Vi.11l(� Ulltll trle pCOpel' t`ee IS �dl(� ilri(� <br /> subiect to inspection, approval or reiection by the c�cY. it is approved by an authorized City Official. <br /> Whenever so ordered, Lhe un�iersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this pe . <br /> Signa re of Ap icant �, Signature o � 'ty Officia <br /> l� G� �`�� ���'` <br /> Code:White—Pile Copy Canary—Inspectc�r's Copy Pink-I�inance Copy Gold—Applicant's Receipt <br />