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GENERAL PERMIT CITYPERMITNO. 8423 <br /> CITY OF ORONO � _ � .� �� <br /> r.O.EOX 66 Date �( % � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> \ �� � <br /> Owner Address s%'s'�..-��� ��f'�Gr;� <br /> r <br /> Contractor � U`� ��✓���1� ��'_ � �1���� Address ���� �'��/ �� � <br /> City License No. � � 7� State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: � 1EW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ <br /> Water Meter (Size_) Fee � Mechanical Equipment Fee $ <br /> Meter# <br /> Remote�$ Moving �Lifting Buildings Fee $ <br /> Municipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> —�. �r'' <br /> Municipal ewer Connection Fee $ e� �; _ 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 /> ACKNOWLEDGEMENT TOTAL <br /> The 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 a�ees under penalty of law State Surcharge: Fee $ <br /> that this permit is strictly limited in scope to the work, � � r,�'� <br /> acUvity or improvement specified; that this perxnit does �r'�7 <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ i -� <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 andJor health department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subject to inspection, approval or rejection by the City. lt 1S 3 roved b an authorized Cit Official. <br /> Whenevex so ordered, the undersigned agrees to correct pp Y Y <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant Signature_of City Official <br /> _ ; ,--, <br /> - �� �� � <br /> -��---- `, <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />