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G <br /> ENERAL PERMIT CITYPERMITNO. g269 ' <br /> CITY OF ORONO Date i� � - <br /> P.O.BOX 66 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> vner �C�I_� . ��I� Address �!��� �l�l�Y� �� , <br /> >ntractor Address <br /> ity License No. State License No. <br /> EMARKS AND SPECIAL CONDITIONS <br /> ERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> ide Plumbing (#fixtures_) Fee $ Water Well Fee $ <br /> ter Meter (Size_) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# Moving �Lifting Buildings Fee $ <br /> inicipal Water Connection Fee $ Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> �nicipal Sewer Connection Fee $ <br /> Fire Fee $ <br /> ❑ PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> WCC SAC Charge Fee $ ther: Fee $ <br /> n 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 xequirements written above. The �— <br /> undersigned understands and agrees under penalty of law State Surcharge: Fee $ <br /> that this permit is strictly 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 $ 'J' �' <br /> sepazate 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 /> �oaes �a�or health depaxtment regulations, �a snau be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection by the c�cv. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned a�ees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant Signature of City Off ial <br /> c <br /> r'� <�(/�.,.� OI'Y�� � <br /> � <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />