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GENERAL PERMIT <br />CITY OF ORONO <br />t1.0.Box 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Owner <br />Contractor <br />('I'I ti' I'I:NMIT Nll. "%igi <br />Address 2 - -If "y C, CA g=m &t 61 Is -r - <br />Address <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />bkc AV� <br />.. * 951t C - <br />PERMIT TYPE AND FEE: XNEW ❑AUDITION <br />Inside Plumbing ( # fixtures_ ) Fee S <br />Water Meter (Size ) Fee S <br />Meter # <br />Remote # <br />Municipal Water Connection <br />OnCopper Q <br />Municip I Sewer ,of iectl0l) <br />Fee S It <br />Fee S 2-V-0- <br />PVC Cast <br />MWCC SAC Charge Fee S <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges jecelpt of this limited <br />permit, including acceptance of all special infc.rmation, <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 tr 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 C.ly <br />ordinance or Stale law. rule or regulation. Ali work shall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subieet to inspection, approval or reJection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in %jolation of the conditions of <br />this permit. <br />Si u re o Applicant <br />1 1 <br />01 <br />Code White I de Cup) Canard In%peL lia's Copt <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 />FOTAL <br />State Surcharge: <br />Fee S <br />F=ee S <br />Fee S <br />Fee S <br />Fee S <br />E= cc S <br />Fee S <br />we, <br />Hee S • C 0 <br />Total Amount Paid to City Hee S 4q180 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Slgnatl#,re of t'It� (4tt�clal <br />Pink 1 inancc Copt Gold Applicant's Receipt <br />