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GENERAL PER1elIIT CITYPERMITNO. _—"�59� , <br /> CITY OF ORONO Dat� �- �� ��� <br /> P.O.BOX 66 <br /> CRYSTAL BAY, MINNESOTA 55323 <br /> (612)473-7357 <br /> Owner ��TC� ���N Address �Ss e��T v i �w <br /> Contractor S T'�/�iv5 �Ec..L Address (��Y�JJ t�[c;h�,.ti�N„ i� (.v �APG� ,r����U <br /> City License No. ��S� State License No. <br /> RF;MARKS AND SPECIAL CONDITIONS <br /> PERMIT TYPE AND FEE: ❑ NEW ❑ ADDITION ❑ REPAIR <br /> Inside Plumbing( # fixtures ) Fee $ On Site Septic System Fee � <br /> Water Meter(Size ) Fee $ Water Well Fee $ , «��� <br /> Meter # <br /> Mechanical Equipment Fee $ <br /> Remote# <br /> Mtxnicipal Water Connection Fee $ Moving/Lifting Buildings Fee $ <br /> ❑Copper Q Land Alteration (Excavation, Fee $ <br /> Grading, Filling, etc.) <br /> Municipal Sewer Connection Fee $ <br /> ❑ PVC ❑ Cast n Other: Fee $ <br /> MWCC SAC Charge 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 /> undersisned understands and a�ees under penalty of law State Surcharge: Fee $- "�f/ <br /> that this permit is strictly limited in scope to the work, <br /> activity or irnprovement specified; that this permit does �� <br /> not grant any authority to do wark or activities requiring Total Amount Paid to City Fee $ �Cl�.��i—� <br /> sepazate permit approvals; and that this permit does noL <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 UIltll t112 pl'Opel' fee 1S pold a11C1 <br /> subiect to inspection, approval or rejection by the c;cy. 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 /> Signature of Applicant �---� Signature of City Official <br /> n � � ��. S��-�.� �C�, <br /> Code:White–File Copy Canary–Inspectur's Copy Pink–Finance Copy Gold–Applicant's Receipt <br />