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GENERAL PERMIT CITY PIRMITNO.=-7270� <br />CITY OF ORONO <br />I O. BOX 06 <br />C RYS I'AL BAY, MINNESOTA 55323 <br />1612) 73-7?57 <br />Owner V.-co Address <br />Contractor �e`1 _�-� � Address <br />State License No <br />RLMARKS AND SPECIAL CONDITIONS <br />fit RMI t 1 YP1 AN1) 1 1 I:: *NF4C ❑ ADDITION <br />Inside Plumbing 1 # fixtures f FCC S <br />Water Meter ISize 1 <br />Meter <br />Remote <br />Fee S <br />Municipal Water Connection Fee S <br />❑ Copper ❑ -- <br />Municipal Sewer Connection <br />^g Fee S <br />❑ PVC ❑ Cast r-1 _ <br />MWCC SAC Charge <br />ACKNOWLEDGLMENT <br />Fee S <br />The unde-signed hereby acknowledges receipt of this limited <br />permit, including acceptarSce of all special information, <br />terms, cundittotis 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 pant ariv authority to do work or activities requiring <br />separate pernut rpprovals: and that this permit does not <br />pant 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 />subject to inspection, approval or rejection by the City. <br />Whenever sit ordered, the undersigned agrees to correct <br />any work found to be in .lulation of the conditions of <br />this permit. <br />Signature of' Applicant <br />A r�. uv-�- <br />XLW PA <br />On Sitc SChti, S%"Icill <br />Water N'Cll <br />Mechanical Equipment <br />Moving/Lifting: Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />FCC S <br />FCC S :;2-0,CZ <br />Fee S <br />Fee S <br />Fee S <br />Other: Fee S <br />After -the -fact Investigation Fee S <br />TOTAL <br />State Surcharge: Fee S _2 `•' <br />Total Amount Paid to City Fee S oC�/ . S0 <br />This pennit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Swi t re of City Official <br />Code: Whitc--I ile Copy Canary Inspector's Copy <br />fink I mane (upy (—ld Applicant's Receipt <br />