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GENERAL PERMIT CITYPERMITNO. g526 � <br /> CITY OF ORONO Date .� - '^-�s �� <br /> r.O.EOX 66 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner � � �� ���-. ' Address /�U S ���7 �LT' . <br /> Contractor � I,�� LJ 1 t'� `I F� � � Address � C'�X �� . 1 - � � <br /> City License No. � � State License No. <br /> REMARKS AND SPECIAL CONDITIONS <br /> ���� ���� w/ 5��,r r���� �' �� ,��� <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 $:. �� � i 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 receipt of this limited <br /> permit, including acceptance of all special information, ^� <br /> terms, conditions or requirements written above. The �� <br /> undersigned understands and agrees under penalty of law State Surcharge: Fee $ <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 ��/' l <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 ox regulation. All work shall be <br /> done in strict compliance with all City ordinances, building <br /> codes and/or ne�zn depaztment regulations, �a sh8u be This permit is not valid until the proper fee is paid and <br /> subject to inspection, approval or rejection by the c�ty. it is approved by an authorized City Official. <br /> Whenevex 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 . Signature f City Offici <br /> � > <br /> � ��� �`�— �� <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy old—Applicant's Receipt <br />