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GENERAL PERMIT CITY PERMIT �� s o s 7 <br /> CITY OF ORONO <br /> P.O.BOX 66 Date � <br /> CRYSTAL BAY,MINNFSOTA 55323 <br /> (61 73-7357 <br />- - — ---- — - <br /> -- - - - --- -- -- <br /> Owner a Address � `�--— - � �'�--- " —- . <br /> Contractor Address <br /> City License No. City <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: O NEW O ADDITION ❑ REPAIR ❑ REMODEL <br /> Inside Plumbing(#fixtwes ) Fee $ Water Well Fee $ <br /> Water Meter(Size ) Fee $ Mechanical Equipment Fee $ <br /> Meter# Fireplace/Wood Stove Fee $ <br /> Remote# Moving/Lifaing Bu�dings Fee $ <br /> Municipal Water Connection Fee $ Iand Altera.tion(Excavation, <br /> ❑ Copper ❑ Grading,Fi7ling,etc.) Fee $ <br /> Design Review Fee $ <br /> Municipal Sewer Connection Fee $ Fire Fee $ <br /> ❑ PVC ❑ Ca.st � <br /> MWCC SAC Charge Fee $ Sprinkler System(Fire) Fee $ <br /> � 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 acknowledges receipt of this limited permit, ���' <br /> includi� acxephance of all special infortnation, temis, condidons or Total Amount Paid to City Fe2 $ gl��.�� <br /> requirements written above. The undersigned unde�lands and agrees <br /> under penalty of law that this pemtit is strictly limited in scope to the work, <br /> activity or improvement specified;that this pemtit does not giant any <br /> authority todo work oractivities requiring separate permitapprovals;and <br /> that this pertnit dces notgrant authority to violate any provision of any City <br /> ordimnce or State law,nile or regula6on All work shall be done in strict �permit is not valid unt�the proper fee is paid and it is approved <br /> compliance with atl City ordinances, bw7ding codes and/or health by an authorized Ciry O�cial. <br /> department regulations,and shall be subje�t to inspa;tion,approval or <br /> rejecdon by the Ciry.Whenever so ordered,the undersigned agrees to <br /> correct any work found to be in vialation of the conditions of this permit. <br /> Signature of Applicant <br /> Si ture f City O�cial <br /> � <br /> Code: White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />