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GENERAL PERMIT CITYPERMITNO. 82�9 <br /> CITY OF ORONO ��� <br /> P.O.BOX 66 Date <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> I �� , f- / <br /> Owner 't Address /�����''e'�C��C< � T • <br /> , / � /' , <br /> Contractor���/ V�.� �� � Address w <br /> City License No.__T�" ��[� / -� 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 /> Munici al Sewer Connection Fee $ �/'�� Fire Fee $ <br /> �PVC ❑Cast n Sprinkler System (Fire) Fee $ <br /> l� /� <br /> MWCC SAC Charge Fee $ —�'`" `-' Other: Fee $ <br /> �n 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 ell 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 �/'6�C��1 <br /> not grant any authority to do work or activities requiring Total Amount Paid to City Fee $ L� �C�� <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 depaxtment 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�tY. 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 /> Sig tur of Applicant Signature f City Offic' 1 <br /> �-�-�,��� � � , �.-- a���� <br /> , <br /> Code:White—File Copy Canazy—Inspector's Copy Pink—Finance Copy Gold—Applicant's Receipt <br />