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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 %LS1.3 S"56 0 <br />Contractor NESZQ �ayp+ M=Um <br />City License No, <br />REMARKS AND SPECIAL CONDITIONS <br />CITY PERMIT NO. 6848, <br />Date 10 —14 Z <br />Address <br />State License No. <br />PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size_.,,) <br />Meter # <br />Remote # <br />Fee S <br />Fee S <br />Municipal Water Connection Fee S <br />❑ Copper F1 <br />Municipal Sewer Connection <br />❑ PVC j4Cast n <br />MWCC SAC Charge <br />.ACKNOWLEDGEMENT <br />v�• <br />Fee S <br />Fee $ <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information. <br />terms, conditions or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />that th4 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 State law, rule or regulation. AU work shall be <br />done in aW.ct compliance with all City ordinances, building <br />codes and/or MOO department regilations, and shall be <br />subject to Inspection, approval or tejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any worst found to be in violation of the conditions of <br />dds permit. <br />SignatuV of Applicant <br />( Re, <br />Code White - File Copy Canary Inspector's Copy <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Fie $ <br />Fre $ <br />F -:e S <br />Fee $ <br />=ee S <br />Other: Fee S <br />After -the -fact Investigation <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S <br />Fee $ IS -0 - <br />Fee $ 5, s0 <br />This permit is not valid until the proper tet: is paid and <br />it is approved by an authorized City Official. <br />Signature,41' l <br />Pink F inance Cop'* (:old Apph,. nt's Receipt <br />