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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. 66951 <br />Date 5-- o? ` O <br />Owner66�Address � �• <br />Contractor ���,�� Address <br />City License No, <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FLE: XNEW <br />Inside Plumbing (# fixtures ) <br />Water Meter (Size ) <br />Meter # _ <br />Remote # <br />❑ ADDITION <br />Fee 5 <br />Fee S <br />Municipal Water Connection Fee S <br />❑Copper <br />Municipal Sewer Connection Fee S <br />❑ PVC ❑ Cast CL--- <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee S <br />The undersigned hereby acknowledges receipt of this limited <br />permit. Including acceptance of ad 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 />— 'vityor Improvement specified. that this permit does <br />not 4'nt any authority to do work or activities requiring <br />"para to r'Rnit approvals; and that this permit does not <br />grant author.'v 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, budding <br />codes and/or health department regulations, and shall be <br />subject to inspection, approval of rejection by the City. <br />Whenever to ordered, the undersigned agrees to correct <br />an) work found to be to violation of the conditions of <br />this permit. <br />Sign urr f Applir t <br />State License No. <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />/ X <br />Fee S 1; <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Fee <br />S <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee S 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 C' y O f- 'i <br />Code; White ile Copy Canary Inspector's Cop► Pink A inance Copy Gold Applicint's Receipt <br />