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GENERAL PERMIT CITYPERMITNO. 8409 � <br /> CITY OF ORONO �. �� <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner � � � Address /�l� �� � <br /> r— � <br /> Contractor � ss <br /> � <br /> City License No. � State License No. <br /> REMARKS AND SPECIAL CONDITIONS _ <br /> � � 3/ �S" �� <br /> PERMIT TYPE AND FEE: �NEW ❑ ADDITION ❑REPAIR <br /> Inside Plumbing(#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter(Size) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> I--� Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC �ast n �� Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ � ' Other: Fee $ <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersi�ed hexeby acknowledgea receipt of this limited <br /> permit, including acceptance of ell apedal in4ormatton, � <br /> terma, conditions or xequiremeats wsltten above. The State Surchar e• Fee $ ` `J <br /> undersigned undexatands and agraes uader penelty of law g • � <br /> that this pemilt is atrlctly llmited in scope to the work, �� <br /> activltY or improvement apecified; that this permit does <br /> n�c �t �y aur�o�� co ao W�k or a����ce8 �q,�� Total Amount Paid to City Fee $ ` <br /> sepazate permit approvals; and that thia pera►it does not <br /> grant authoritY to violate an9 Provieion of any City <br /> ordineace or State law,rule or regiilatlon.AII work shall be <br /> done in atrlct complience with all CitY ordinencea,buildin� <br /> codes and/or health departmeat regulatlons. aad ahell be 'This permit is not valid until the proper fee is paid and <br /> subiect to inapection, approval br rejectlon by the City. it is approved by an authorized City Official. <br /> Whenever eo ordered, the undersigned agreea to cottect <br /> aay work found to be in violatioa of the conditions oP <br /> this permit. <br /> Signature Applicant Signatu of City Official <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />