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GENERAL PERMIT CITYPERMITNO. szgo <br /> CITY OF ORONO Date �a� � � <br /> r.o.aox 66 <br /> CRYSTAL BAY,MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner A�� ��h Address� � � �� �t T • <br /> Contractor Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑REPAIR <br /> Inside Plumbing(#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter(Size) Fee $ Mechanica.l Equipment Fee $ <br /> Meter# <br /> Remote,# Moving/Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ <br /> La.nd Alteration (Excavation, Fee $ <br /> ❑Copper ❑ Grading, Filling, etc.) <br /> Municipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $��� Other: Fee $ <br /> L <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> , <br /> ACKNOWLEDGEMENT TOTAL <br /> The underslgned hereby acknowledgea receipt of this limited <br /> permit, includ9ng acceptence of all spedal informatlon, <br /> terms, condittons or xequiremenis wiitten above. The State Surchar e• Fee $ <br /> undersigned undezatands and agrees under penaltq of law g • <br /> that this Permit is atrictlY limited in ecope to the work, �jq <br /> , a <br /> activity or improvement specifled; that this Permit doea ��CXJ <br /> not grant anY authorlty to do wark or activitiea requiring Total Amount Paid to City Fee $ <br /> sepazate permit aPprovels; and that thie permit doea not <br /> grant authoxitY to vlolate any provieton of any CitY <br /> ordinance or State law,rule or regulation.All work ahell be <br /> doae iln strlet compliance with ali CitY ord�laancea,building <br /> codes andJor health depertmeat regulatione, end ahaII be 'This permit is not valid until the proper fee is paid and <br /> sub�ect to inapect3oa, approval or xejection by the City, it is approved by an authorized City Official. <br /> Whenever so ordered, the undex�gned egreea to correct <br /> any work found to be in vlolat[oa of the conditlona oP <br /> tk�s permit. <br /> Signature of Applicant Signa re of City fficial <br /> `-��Y1�- � �J <br /> Code:White—F�le Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />