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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. __69261 <br />Date I - I W � <br />Owner Vr ANDF_2Sn(\J Address 18,557 C0AX_0eDr 3 <br />Contractor vii AsimAXA PLF%� Address WASIZArA � <br />City License No. State License No. <br />REMARKS AND SPECIAL CONDITIONS <br />SAC 'Pd �ve_m, t �to� <br />PERMIT TYPE. AND FEE: XNEW ❑ ADDITION ❑ REPAIR <br />Inside Plumbing ( # fixtures ) Fee $ I On Site Septic System t-ce S_ <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />Fee $ <br />�� <br />O U <br />Municipal Water Connection Fee $_;X6 <br />Copper a <br />� eo <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast <br />MWCC SAC Charge Fee $ f ?A <br />ACKNOWLEDGEMENT <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of as 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 />activity or improvement specified; that this Permit does <br />not grant any authority to do work or eFtivides 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. All work shall be <br />done in strict compliance with as City ordinances, building <br />codes and/or health department regulations, and shall be <br />abject 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 />Water Well Fec S _ <br />Mechanical Equipment Fee S— <br />Moving/Lifting Buildings Fee S <br />Land Alteration (Excavation, Fee S <br />Grading, Filling, etc.) <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee S /00 <br />�/, 00 <br />Total Amount Paid to City Fee S ly/. <br />This permit is not valid until the proper fee is pall and <br />it is approved by an authorized City Official. <br />Si m• t e f City Offic' <br />Code: White -Pile Copy Canary- lospectur's Copy Pink I mance Cop> Gold Applicant's Receipt <br />