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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 />Owner ^ _____________ <br />Contractor S _____ <br />City License No ^ ^ <br />CITY PERMIT NO. 839t <br />Address / ^ ^^/)or . <br />Address j j^ ~K- )/(L^ <br />REMARKS AND SPECIAL CONDITIONS <br />I " in ____>j- / '^foO I n <br />State License No. <br />PERMIT TYPE AND FEE: <br />Inside Plumbing (#fixtiiresi^) <br />Water Meter (Size__) <br />Meter#_____________ <br />^ NEW □ ADDITION □ REPAIR <br />Fee S >^0 <br />Fee S-------------- <br />Remote #. <br />Municipal Water Connection <br />Q Copper Q____ <br />Fee S. <br />Municipal Sewer Connection <br />5?PVC DCast Q. <br />MWee SAC Charge <br />On Site Septic System <br />Fee S <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fee S <br />Fee S. <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 S. <br />Fee S. <br />-Fee S. <br />. Fee S. <br />ACKNOWLEDGEMENT <br />The undeniKned hereby acknowledces receipt of this limited <br />permit* includins acceptance of all special Information, <br />terms, conditions or requlrcmenU written above. The <br />underslsned 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 \iolate any prodsion 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 relectlon by the City. <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 />Signatup^f Appli^nt <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S..CD <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: Wliltc-Hlc Copy Cinuy-lnspTctor’s Copy Wnk-Flnancc Copy Gold-Applicant's Receipt