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GENERAL PERMIT CITYPERMITNO. g45� <br /> CITY OF ORONO <br /> ' � <br /> P.O.BOX 66 Date — �� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner � � � Address � �� �Z������ <br /> Contractor /��` Address �� ��� � / �2� �� . <br /> City License No.��� State License No. , �1 Tl�-a <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ 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 /> � � �, S-v Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Co tion Fee $ <br /> � Fire Fee $ <br /> ❑ PVC [�I C.`ast n 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 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 permit does �1 <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ " <br /> separate Permit approvals; and that this permit does not <br /> grant authority to violate any provision of any City -�'�j� ,�� <br /> ordinance or State law,rule or regulation. All work shall be <br /> done in strict compliance with all City ordinances, building <br /> �oaes �„aior ne�r,� department 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�ty. it is approved by an authorized City Official. <br /> Whenever so oxdered, the undersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant �`A����— Signatur of City Off' al <br /> �� ���� <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />