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+M► ''� - <br /> .CAL PERMIT CITYYERMITNU. _-�2�5 + <br /> . OF ORONO � _S� <br /> P.O.BOX 66 Date � � <br /> fAL BAY, MINNESOTA 55323 <br /> (612) 473-7?57 <br /> �-�� � Address � � � ���(l/l_ � <br /> r - � Address � " � <br /> .;ense No. State License No. <br /> ARKS AND SPECIAL CONDITIONS <br /> ^ ������. � �� <br /> PERM[T TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> lnside Plumbin� ( # fixtures ) Fee $ On Site Septic System Fee $ <br /> Water Meter (Size ) Fee $ Water Well Fee $ <br /> Meter # � <br /> Mechanical Equipment Fee � <br /> Remote# <br /> Municipal Water Connection Fee $ Moving�Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Municipal Sewer Conn�ction Fee $ <br /> ❑ PVC ❑ Cdst n Other: Fee $ <br /> MWCC SAC Charge Fee $ After-the-fact Investigation Fee $ <br /> ACKNUWLEDGEMENT TOTAL <br /> Tt�e undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of all special information, /� <br /> terms, conditions or requirements written above. The State Surcharge: Fee $ • v C', <br /> undersigned understands and a�ees under penalty of law <br /> Lhat this permit is stricUy limited in scope to the work, � <br /> activity or improvement specified; that this perxnit does � <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ <br /> sepazate permit approvals; and that this permit does not <br /> �ant autttority to violate any p'tovision 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 department regulations, and shall be This permit is not valid Ulltll t�le ]�1'Oj�er fee 1S polC� �llllj <br /> subject to inspection, approval or reiection by the c�ty. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agxees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Si n re of Applicant � Sign r of City Offi 'al �. <br /> � � � ,� � � _ <br /> Code: White—1 ile Copy Canary—Inspector's Copy Pink—I inance Copy Gold—Applicant's Receipt <br />