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GENERAL PERMIT CITYPERMITNO. �824 <br /> CITY OF ORONO ��� ��--- <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 3-7357 <br /> Owner L�'�� � �s�'y�' Address �.�l��S 7` (_.(� ��(i� � <br /> Contractor � a- � � � l 1\ Address 5����s ��C���7i (�,�.� '''�- � �-a�u <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> �� L <br /> �� � � ' <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 /> � Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Connection Fee $ — <br /> Fire Fee $ <br /> ❑ PVC ❑Cast 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 xeceipt of this limited <br /> pexmit, including acceptance of ell special information, � <br /> terms, conditions or requirements written above. The <br /> undersigned understands and agxees under penalty of law State Surcharge: Fee $ <br /> that this permit is strictly limited in scope to the work, <br /> activity or irnprovement specified; that this permit does Q f[�`�/ ' <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee .p I�v � <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 /> �oaes �aior health department regulations, �a sheu be This permit is not valid until the proper fee is paid and <br /> sub;e�t to inspection, approval or rejection by r�e c�ty, it is a roved b an authorized Cit Official. <br /> Whenever so ordered, the undersigned agrees to conect pp Y Y <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> % <br /> Signature of Applicant Si a ur of City Official � <br /> � ^ � . ��; ���t��.�.:_, ��C� <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanYs Receipt <br />