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GENERAL PERMIT CITYPERMITNO. g444 � <br /> CITY OF ORONO �_�;�� <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> � ��� <br /> Owner � SQ� Address / L� �--�' l E''�✓- <br /> Contractor L�_►�l�'��1�'►� vl��I l�c� � Address <br /> City License No. � .�� State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: NEW ❑ ADDITION ❑ REPAIR <br /> � <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 $ _ <br /> Land Alteration (Excavation, Fee $ <br /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ _ 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 Q j <br /> undersigned understands and agrees under penalty of law State Surcharge: Fee ,p <br /> that this permit is strictly limited in scope to the work, �j . <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 $ � <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 �aior health department regulations, �a snau be This permit is not valid until the proper fee is paid and <br /> subiect to insnection, 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 perxnit. <br /> Signature of Applicant � Signature of City Of�ci <br /> � <br /> � <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />