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GENERAL PERIVIIT CITYPERMITNO. -f �5"�9 � <br /> CITY OF ORONO Dat� ,�=� � - r <br /> r.o.aox 66 � <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 1 <br /> /, 1 <br /> Owner � 1�-'�i��--- Address � l/ t-k�'�JC V 1 � <br /> � <br /> Contractor � � Address ����� // GU(/ ��S - ���/�`C� �� <br /> City License No. �•��' State License No. <br /> RF�,MARKS AND SYECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: W ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing ( # fixtures ) Fee $ On Site Septic System F�e $ <br /> Water Meter(Size ) Fee $ Water Well Fee $���.��lJ <br /> Meter # <br /> Mechanical Equipment Fee $ <br /> Remote# <br /> Municipal 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 n Other: 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 <br /> undersigned understands and a�ees under penalty of law State SUI'Clldi�e: Fee $ ' <br /> that this permit is strictly limited in scope to the work, <br /> activity or improvement specified; that this permit does <br /> i. � <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 /> �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 department regulations, and stiall be This permit is not valid until the proper fee 1S pa1C� 3I1C� <br /> subiect to inspection, approval or reiection by the c�cy. it is approved by an authorized City Official. <br /> Whenever so ordered, the undersigned agrees to correct <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Signature of Applicant Sig u e of City Official <br /> ��� � � ' ,; �l ������r <br /> � -��� <br /> Code:White—Pile Copy Canary—Inspectur's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />