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GENERAL PERMIT CITYPERMITNO. g25� � <br /> CITY OF ORONO Date ' � � � --��" <br /> r.O.EOX 66 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> ��� ,�j c�� r� � j�� ��� ,��rJ� �7" . <br /> Owner � Address <br /> Contractor / Address <br /> City License No. State License No. <br /> REMARKS AND SPECIAL CONDITIONS <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 /> Land Alteration (Excavation, Fee $ <br /> Municipal Water Connection Fee $ - Grading, Filling, etc.) <br /> ❑Copper � <br /> Municipal Sewer Connection Fee $ Fire Fee $ <br /> ❑ PVC ❑Cast n � Sprinkler System (Fire) Fee $ <br /> � '�`-�,C� <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 <br /> undersigned understands and a�ees under penalty of law State Surcharge: Fee $ <br /> that this perxnit is strictly limited in scope to the work, <br /> activity or unprovement 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 and/or health department regulations, and shall be This permit is not valid until the proper fee is paid and <br /> subiect to inspection, approval or reiection by the c�cv. 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 Signat e of City Offcial <br /> `� � <br /> ����-�,.G � �'% t�= ��C;�s--�'�c.� �h-) <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />