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GENE AL PERMIT CITYPERMITNO. � s5s� <br /> CITY OF ORONO <br /> P.O.BOX 66 Date <br /> CRYSTAL AY,MINNESOTA 55323 <br /> ( 12)473-7357 <br /> �` — O, <br /> Owner r iv Address `� / �. e. • • <br /> Contractar �I r�� 1�� ddress <br /> City License No. State License No. <br /> REMARKS AND SPE IAL CONDITIONS <br /> PERMIT TYPE AND EE: �NEW ❑ ADDITION ❑REPAIR <br /> Inside Plumbing(#fixtu es_) Fee $ Water Well Fee $ s��� <br /> Water Meter(Size_) Fee $ Mechanical Equipment Fee $ <br /> Meter# <br /> Remote# Moving/Lifting Buildings Fee $ <br /> Municipal Water Conne tion Fee $ Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> ❑Copper <br /> Municipal Sewer Conne tion Fee $ Fire Fee $ <br /> ❑ PVC ❑ ast n Sprinkler System (Fire) Fee $ <br /> MWCC SAC Charge Fee $ Other: Fee $ <br /> On Site Septic System Fee $ After-the-fact Investigation Fee $ <br /> ACKNOWLEDGEME T TOTAL <br /> The undersigned he by acknowledges receipt of this limited <br /> permit, including cceptance of all special information, <br /> terma, conditions or requiremeats watten above. The State Surcharge: Fee $� <br /> undersigned unders ds and a�ees under penalty oP law <br /> that thia permit is strlctly limited in acoDe to the work, <br /> activity or imgrov ment specified; that this Hermit doea <br /> not �ant any au ority to do wa�k or activities requixina Total Amount Paid to City Fee $_ <br /> separate permit aP rovals; and that this Dermit doea not � <br /> grant authority t violate any Drovision of anY CitY <br /> ordinance or State aw,rule or regulation.All work shall be <br /> done in strict com lisnce with all City ordinances,buildinQ <br /> codes and/or heal devartment reaulations, and sheu be This permit is not valid until e proper fee is paid and <br /> subiect to inspect[ n, apDroval or relection by the c;zr. it is approved by an authorized lty �f�1C1�. <br /> Whenever so orde d, the underei�ed a�{rees to correct <br /> any work found be in violatlon of the conditions of <br /> Ehis permit. <br /> Signature of Applic t Signature of City Offic' <br /> .___.—! <br /> Cod :White—File Copy Canary—Inspector's Copy Pink—Finance Copy Gold—ApplicanY Receipt <br />