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'ENERAL PERMIT <br />CITY OF ORONO <br />)wner <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 5533 <br />(61 2) 473-7357 <br />fCN <br />Address eV <br />CITY PI Rh11T NO. 7233 1 <br />Date <br />//_ 7 3 <br />N, R,eQ wAj <br />Contractor J � � 0m IVSUI� AddressQ�/�N/!�l G S [ D <br />City License No. State Li;:ense No. _ <br />REMARKS AND SPECIAL CONDITIONS <br />t 50o .�S_ P�/J�4� DrOm AJ <br />PERMIT TYPE: AND FEE: r NEW ❑ ADDITION <br />Imide Plumbing ( # fixtures_. ) Fee S <br />Water Meer (Size_) Feta $ <br />Meter # <br />Remote # <br />Municipal Water Connection <br />Hee S _.. <br />❑ Copper r ._. <br />Municipal Sewer Connection <br />Fee S <br />❑ PVC ❑ Cast CL� <br />MWCC SAC Charge Fee $ <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit. including acceptance of all xsecial information. <br />terms. conditions or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />that this permit is strictly Umited in scope to the work. <br />activity or improvement specified; tha•: 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 !aw. rule or regulation. All work shall be <br />done in strict compliance with all City ijordinances. building <br />codes and/or health department regulations. and shall be <br />sublect to inspection, approval or relection by the City. <br />Whenever to (ordered. the undersigned. agrees to correct <br />any work found to be in violation of the conditions of <br />this permit. <br />Signature 40plicant <br />J <br />Code White - I file Cupy Conary Inxpc1 tint's Copy <br />)XR EPA I R <br />On Site Septi: System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation. <br />Grading, Filling, etc.) <br />Other: <br />After -the -fart Investigation <br />TOTAL <br />Fee S Zo eyo <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />:tate Surcharge: Hee S <br />0 <br />S"D <br />1-otal Amount Paid to City Fee S ZO <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Silmature oi" Cite Official <br />Pink I inance Cope Gold Applicant's Receipt <br />