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GENERAL PERMIT CITYPERMITNO. --�55� I <br /> CITY OF ORONO Dat� �' .— � `--�1 <br /> P.O.BOX 66 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner � ' Address ��O ���-�-��- l--/ /Q'� <br /> Contractor �� - � '� Address � � •- 7'� <br /> �/�� L_C��t-G�l 1��, <br /> City License No. l State License No. �"5�54�—G, <br /> RF,MARKS AND SPECIAL CONDITIONS <br /> /� — C.� � �Z ` .� - � - e��_ <br /> � `" -t'�1 rl _. � _� ' - <br /> yt C��'�/ # <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing ( # fixtures ) Fee $ On Site Septic System Fee $ <br /> Water Meter (Size ) Fee $ Water Well Fee $ <br /> Meter # �j, <br /> Mechanical Equipment Fee $ � f� v" <br /> Remote# <br /> Mixnicipal Water Connection Fee $ Moving/Lifting Buildings Fee $ <br /> ❑Copper ❑ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Municipal Sewer Connection Fee $ <br /> ❑ PVC ❑ Cast [� Other: �a-� Fee $ / ' � <br /> MWCC 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 all special information, !� <br /> terms, conditions or requirements written above. The State SU1'C�1dI'g2: Fee $ <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 � � / t � <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 and/or health department regulations, and shall be 1'111S p017111t 1S 170t Valld Ulltll ttle pl'OpeT fee is paid and <br /> subiect to inspection, approva� or reiection by the c;cY. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to conect <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant . � Sig re of City Official <br /> _. � �Z _ <br /> /��C �� /� � �� �.-�,/� <br /> Code:White—File Copy Canary—Inspectur's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />