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GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />CITY PERMIT NO. 8432 <br />Date <br />Owner,PAC.iSer\-^ <br />Contractor. <br />City License No---------V ___________ <br />Address. <br />Address, <br />/jQ< AeFd!^ <br />State License No., <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE <br />Inside Plumbing (#fixtures_ <br />NEW □ ADDITION □ REPAIR <br />Water Meter (Size—) <br />Meter#_______ <br />Remote #. <br />Municipal Water Connection <br />,opper <br />Municipal Sewer Connection <br />l^PVC □ Cast Q. <br />M>VCC SAC Charge <br />On Site Septic System <br />Fee S. <br />Fee S. <br />Fee S. <br />Fee S 30 : <br />■kK.rJ. s <br />Fee S. <br />Fee S. <br />Ot <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire____________________ <br />Sprinkler System (Fire) <br />Other:_____________ <br />After-the-fact Investigation <br />Fee S. <br />Fee S. <br />Fee S. <br />Fee S. <br />Fee $. <br />Fee S. <br />Fee S. <br />Fee S. <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt ol 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 <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 <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, and shall be <br />subject to inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in \'iolation of the conditions of <br />this permit. <br />Signature of Applicant <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee So <br />Fee S. <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />Code: \Wiitc-I-ilc Copy Canary-Inspector’s Copy Pink-Finance Copy Gold-Applicant’s Receipt