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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,WiA <br />Con tractor C> lOVA <br />City License No.. <br />CITY PERMIT NO.' 6858 ' <br />Date,I 0" ^ (q — <br />Address. <br />Address. <br />I ^£^4 T')t^ldoQ P^dlC QA <br />REMARKS AND SPECIAL CONDITIONS <br />State License No. <br />-<4-2- <br />PERMIT TYPE AND FEE: jfsfNEW □ ADDITION <br />Inside Plumbing ( # fixtures___) Fee $_______ <br />Water Meter (Size___) Fee S_______ <br />Meter #_____________________ <br />Remote # <br />Municipal Water Connection <br />D Copper D----- <br />Fee S. <br />Municipal Sewer Connection <br />□ pVC DCast Q. <br />Fee S. <br />MWCC SAC Charge Fee S. <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 />Other;._________________ <br />After-the-fact Investigation <br />Fee S. <br />Fee S. <br />Fee S_(3^-e- <br />Fee S-------- <br />Fee S_____ <br />Fee S. <br />Fee S, <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowl<fdges receipt of this limited <br />permit, including acceptance of all special Information, <br />terms, conditions or requirements written above. The <br />underdgned 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 SUte 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 violation of the conditions of <br />this permit. <br />Signature of Applicant / <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S / <br />Fee S <br />This pemiit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Code: Whlte-rUc Copy Canaiy-lnspcctor’s Copy Pink-nnance Copy Gold-Applicant's Receipt