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GENERAL PERMIT CITYPERMITNO. _—�200 � <br /> CITY OF ORONO <br /> P.O.BOX 66 Date �G — /�-- �� <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> . <br /> Owner ���d?�� Address ��.� �i��uu�/1v� �� � . <br /> Contractor Address � <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> ` d� -� ��c t-4- 2� rv'� w urn�' SYS'7�� <br /> PERMIT TYPF. AND FEE: ❑ NEW ❑ ADDITION �REPAIR <br /> lnside Plumbing � # fixtures ) Fee $ On Site Septic System Fee $��`� <br /> Water Meter(Size ) Fee $ Water Well Fee $ <br /> Meter # <br /> Mechanical Equipment Fee $ <br /> Remote# <br /> Mlxnicipal Water Connection Fee $ Moving/Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Mtinicipal Sewer Connection Fee $ <br /> ❑ PVC ❑ Cast n Other: Fee $ <br /> M'vVCC SAC Charge Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEMENT TOTAL <br /> The undersigned hereby acknowledges receipt of this limited <br /> permit, including acceptance of ell special information, <br /> terms, conditions or requirements written above. The State Surcharge: Fee $ "� b <br /> undersigned understands and a�ees under penalty of law <br /> that this permit is strictly limited in scope to the work, <br /> activity or improvement specified; that this permit does ,(�'' <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ � r d' 0 <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 /> codes and/or health depaztment regulations, and shall be This permit is not valid Uritll t110 prOpel' fee is paid and <br /> sub]ect to inspecUon, approval or relection by the c�tv. it is approved by an authorized City Official. <br /> Whenever so ordered, Lhe undersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this perxnit. <br /> Signature A p i nt Signature of City Official <br /> �� �,���-� <br /> Code:White—File Copy Canazy—Inspectur's Copy Pink—t'inance Copy Gold—Applicant's Receipt <br />