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GENERAL PERMIT CITYPERMITNO. g186 � <br /> CITY OF ORONO ` _ <br /> P.O.BOX 66 Date ` , �� � �� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> � ' �c��s� Address �t�-S �� �� �� ' <br /> Owner _ <br /> Contractor �� ��� ��� ' Address x ��� <��1� �� /-1� , <br /> City License No. ���� State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> � " 1 0�� � �. 1� "��1 �— � /���� �j�• (���1/��(�Cl� <br /> w� C'_(.l✓�i� ►�'l � Y��/1 <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 $ <br /> 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 $ �d�' After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hexeby 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 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 �' <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 and/or health department regulations, �a snau be This permit is not valid until the proper fee is paid and <br /> subiect to insnection, 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 /> Signature of Applica t Signature of City Offi ' 1 <br /> r <br /> �.�a� � ~ �� or� �.� <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />