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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. 6824 1 <br />Date — ;�? — oZ <br />Owner - /It C_ M, llax,.. Address U � �� eL-_� <br />Contractor �U 1 jZAddress O U/ So <br />City Lic ;e No. State License No. _ <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: ❑ NEW <br />Inside Plumbing ( # fixtures ) <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />❑ ADDITION <br />Fee $ <br />Fee $ <br />Municipal Water Connection Fee $ <br />❑ Copper <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast i 1 <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <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 this permit is strictly limited In scope to the work, <br />activity or improvement specified; that this permit does <br />nut grant any authority to do work or activities requiring <br />separate permit approvals; and Liat 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 all City ordinances• building <br />codes endlor health department regulations, and shall be <br />wrbject to inspection, approval or rejection by the City. <br />Whenever so ordered, the •.mdersigned agrees to correct <br />•ny work found to be In violation of the conditions of <br />this permit. <br />Si ai'tt e of Ap icant , <br />M REPAIR <br />On Site Septic System Fee S Od <br />Water Well Fee $ <br />Mechanical Equipment Fee $ <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation, Fee $ <br />Grading, Filling, etc ) <br />Other: __ Fee $ <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S • SO ! <br />Fee $ () d 1 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />jign'lture of City Official <br />� _- _ <br />Code: White - Tile Copy Canary Inycctor's Copv <br />Pink I inance Copy Gold Applicant's Receipt <br />