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I <br />L I <br />GENERAL PERMIT <br />CITY OF ORONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612)473-7357 <br />Owner Itth ___________ <br />ContractorChgi 0 la ^ <br />City License No_____------------------ <br />REMARKS AND SPECIAL CONDITIONS <br />_________^ A) <Lir y fi <br />.h' <br />■f <br />CITY PERMIT NO.8321 <br />Date /- 2/- Si. <br />Address ^ ^ C ke l. ^ <br />lac <br />Address ^ ^ . /yia <br />State License No________________ <br />PERMIT TYPE AND FEE: <br />Inside Plumbing (#fixtures __) <br />Water Meter (Size__) <br />Meter# ______________ <br />□ NEW IB^DDITION □ REPAIR <br />Fee $ <br />Fee S <br />Remote #, <br />Municipal Water Connection <br />n Copper f~l <br />Municipal Sewer Connection <br />□ PVC □ Cast Q <br />MWee SAC Charge <br />On Site Septic System <br />Fee S <br />Fee S <br />Fee S._ <br />Fee S_ <br />Water Well <br />Mechanical Equipment <br />Moving /Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fire <br />Sprinkler System (Fire) <br />Other:.____________ <br />After-the-fact Investigation <br />Fee S <br />Fee i 30 <br />Fee $____ <br />Fee S____ <br />Fee S <br />Fee S <br />Fee S <br />Fee S <br />ACKNOWLEDGEMENT <br />Th« undenisned hereby ecknowlcdgee receipt of this limited <br />penniii Includlnt acceptance of all q>eclaJ information, <br />ierma, conditions or requirements urdtien above. The <br />undeieigned understands and agrees under penalty of law <br />that this permit is strictly limited in scope to the work, <br />acUviiy or improvement ^tcifled; that thU permit does <br />not grant any authority to do work or activities requiring <br />separau permit approvals; and that this permit does not <br />grant authority to violate any provision of any City <br />ofilinance or State law. rvile or regulation. AH work shall be <br />done In strict compliance with all City ordinancas, building <br />codes and/or health department regulations, and shall be <br />sublect to inspection, approval or reiection by the City. <br />Whenever so ordered, the underslgiied sgrsai to correct <br />any work found in violation of the conditions ol <br />this permit <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S SO <br />Fee <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 />'^4^ 5r <br />Code: Whltn -f Oe Copy Caniry-InHmctor'f Copy Fink-Fingact Copy Gold-Applkaat't Receipt