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CITY YERMIT NO. __ �41� � <br /> GENERAL PERMIT <br /> CITY OF ORONO �--_ �_�� <br /> Y.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (6]2) 473-7?57 <br /> Owner Adclress <br /> ('<�ntra�tor Address � � ' �� /l/�'"' �� � <br /> City I_icense No. State License No. <br /> RE:MARKS ANll SPECIAL CONDITIONS <br /> � � � � <br /> P�:RM[T TYPE AND Ff�.E: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> lnside Plwnbin� ( # fixtures ) Fee $ On Site Septic System Fee $ <br /> Water Meter (Si�e ) Fee $ Water Well Fee $ <br /> Meter # �� <br /> Mechanical Equipment Fee $ <br /> ]Zemote# <br /> Municipal Water Conn�ction Fee $ Moving�Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Municipal Sewer C�nn��tioil Fee $ � <br /> ❑ PVC ❑ Cast n Other: Fee $ �• � <br /> MWCC SAC Char�� Fee $ After-the-fact Investigation Fee $ <br /> ACKNUW LEDGEM ENT TOTAL <br /> T}�e 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 State Surcharge: Fee $ " <br /> that this permit is stricUy limited in scope to the work, <br /> activity or improvement specified; that this permit does �j � <br /> not grant any authority to do work or activities requiring Total Amount Paid to City F0e $ <br /> separate permit apProvals; and that this permit does not <br /> �ant 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 and/or health depaztment regulations, and shall be TI'11S peT1111t is not valid Ulltll t11e ]JT'Opei f2e 1S pd1C� illll.j <br /> subiect to inspection, approval or relection by the City. lt 1S appT'OVeCl b}� 817 dUt�l01'1Ze(� Clty OtflClc'll. <br /> Whenever so ordered, the undersigned agrees to correct <br /> any work found to be ii� violation of the conditions of <br /> this permit. <br /> Signaturr, of App c� nt �� � Signat r of City Official , /Ps� <br /> ���� �� ( <br /> Code: White—I ile Copy Canary Inspector's Copy Pink—I inance Copy Gold—Applicant's Receipt <br />