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�ENERAL PERMIT ��P�� N� s s o 5 <br /> CITY OF ORONO <br /> P.O.BOX 66 Date �� ��_�� <br /> CRYSTAL BAY,NIINNESOTA 55323 � <br /> (612)473-7357 <br /> Owner Address���� /'�� r �, <br /> r� , /,. // <br /> Contractor���u , _v1 S�� Addr��`�`� ��,�G�S/�� �C f / ��= <br /> City License No. ��� City <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: � NEW O ADDITION ❑ REPAIR � ❑ REMODEL <br /> Inside Plumbing(#6a�tures ) Fee $ Water Well Fee $ <br /> Water Meter(Size ) Fee $ Mechanical Equipment Fee $ <br />' Meter# Fireplace/Wood Stove Fee $ <br /> Remote# Moving/Lifting Bu�dings Fee $ <br /> Municipal Water Connection Fee $ Land Altera.tion(Excavation, <br /> O Copper ❑ Grading,F�ling,etc.) Fee $ <br /> Municipal Sewer Connection Fee $ ��� �ign Review Fee $ <br /> ` / Fire Fee $ <br /> �J PVC�t ❑ <br /> �' Sprinkler System(Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other. Fee $ <br /> On Site Spetic System Fee $ � � <br /> After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> State Surcharge: Fee $ �� <br /> The undersigned hereby acknowl� receipt of this limited permit, �� <br /> including aaxpmnce of all special information, terms, condidons or Total Amount Paid to City Fee $ ��'� <br /> reqwrements written above. The undersigned understands and agrees <br /> under penalty of Iaw that this permit is strictly limited in scope to the work. <br /> aciiviry or improvement specifietl;that this pertnit dces not grant any <br /> authority to do work or activiues requiring sepa�ate permit approvals;and <br /> ttiat this pertnitdces notgrantauthority to violate any provision ofany City <br /> ordirtance or State law,nile or regulation.All work shall be done in strict '�pe�t is not valid unt�the proper fee is paid and it is approved <br /> compliance with all City ordinances, bm7ding codes and/or health b an authorized Ci ��Cl�. <br /> department regulabons,and shall be subject to inspection,approval or y ry <br /> rejection by the City.Whenever so ordere�,the undersigned agrees to <br /> correct any work found to be in violadon of the conditions of this permit. <br /> Signature o �pplicant <br /> � Signature of City O�cial <br /> �_ .� . <br /> � � <br /> Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />