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MA <br /> •t ! d ;+ 4 t fFk r <br /> i <br /> h <br /> nage <br /> Permitf <br /> 4; <br /> Es'. <br /> s <br /> Contractor Address- <br /> 4i <br /> Owner-- Address — .- <br /> `;tate License Ne. — —_ Village License <br /> VIL LAGT£ OF OFiONO <br /> w+ <br /> Crystal Bay, 'Minnesota <br /> Date----- <br /> Parcel <br /> ate ----Parcel No. -- <br /> Section No_ Lot__ Block -- <br /> Plat No. — <br /> i <br /> Other Description: <br /> j <br /> t <br /> I hereby agree that, in case a p rmit is granted, all tiork which shall be done ad :11 materials which shall be used, shall <br />! c Code of OTo,:o applicable thereto, and shalt, include all :: ;ditional spcci5 <br /> comply with the Villagritions as listed below. <br /> e — <br /> F <br /> f k. <br /> Install plumbing systemSinature of applicant s: Fee $-- g 1 p � . ; <br /> Installs <br /> s('svagc disposal systems: Fee — ----- ------ — '` <br /> Repair <br /> . <br /> a Inst:iL <br /> water supply systems: Fee <br /> Repair Si-natui• t;f Villagc 0,icial <br /> .. <br /> —_ <br /> Fec ----- IL ,, <br /> Toial amount lxiid to Village. .. ... ? - -- -- ----- <br /> S Y <br /> � °^"k iT.a,�Pw+� .: w x3 ..'«r�1w-i„�i.#'1",uh� 4�«"r wr .> •.'"-R. <br />