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GENERAL PERMIT CITYPERMITNO. 512� � <br /> CITY OF ORONO ��f � � 5 <br /> P.O.BOX 66 Date _�,__�__ <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner L�� ��I�� Address ��W � �U�� � � _ <br /> Contractor LLl�l� �� � C� C��1 Address ��� �' <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> _ C <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION �,I R PAIR <br /> Inside Plumbing (#fixtures_) Fee $ ter Well Fee $ <br /> Water Meter (Size_) Fee $ Me hanical Equ ment Fee $ <br /> Meter# _ <br /> Remote�# Movi /Lifting B ildings Fee $ <br /> Land Alteration (E ation, Fee $ <br /> Municipal Water Connection Fee $ - Grading, Filli g, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fe $ _ Fire Fee $ <br /> ❑ PVC ❑Cast Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: Fee $ <br /> On Site Septic System Fee After-the-fact Investigation Fee $ <br /> ACKNOWLEDGE NT TOTAL <br /> The undersigned he by acknowled s receipt of this limited <br /> permit, including a eptance of special information, /_-Q <br /> terxns, conditions or requiremen written above. The J <br /> undersigned understan and agree under penalty of law State Surcharge: Fee $ <br /> that this permit is strictl limited in scope to the work, <br /> activity or unprovement sp ified; that this permit does <br /> not grant any authority to do k or activities requiring Total Amount Paid to City Fee � <br /> sepazate permit approvals; and that this Permit does not <br /> grant 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 department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or rejection by the c�cy. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant Signature of City Official <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />