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GENERAL PERMIT �ITYPERMITNO. 8391 � <br /> CITY OF ORONO c�� j����, <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612) 473-7357 <br /> Owner � �� Ct GtT�� Address �L� /�����,�T� �/ �-�r�C �ic� <br /> Contractar L�u n e.� l�'��� Address V'1'��-pi�i cc�n <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 /> 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 Q 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 L""�t� <br /> State Surchar e: Fee $ d�� <br /> undersigned understands and agrees under penalty of law g <br /> that this permit is strictly limited in scope to the work, <br /> activity or improvement specified; that this permit does ��J.-.!� <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 �aior health department regulations, �a �nau be This permit is not valid until the proper fee is paid and <br /> subject to inspection, approval or rejection by the City. lt 1S a roved b an authorized Cit Official. <br /> Whenever so oxdered, the undersigned agrees to correct pp Y Y <br /> any work found to be in violation of the conditions of <br /> this permit. <br /> Sig ature of Ap icant Signature of City Official <br /> � <br /> Code:White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />