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City Nrmit.l0 5186 <br />Contractor STft=j/eAyS WELL- Address &W« h -4//U <br />Owner 1T��j�_ik �me_Scv�) Address '196s— goT Inez <br />State License No, <br />Parcel No, <br />City License No, <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay. Minnesota <br />473-7357 i 7A <br />Date <br />Section No. Lot Block Subdivision <br />Plat No. <br />Other Description: <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be u%ed, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />C o r r c+ F s rAllo L JE7LW=EZooM P -J. LCT— BE; s�-ntT •ra r_ 1 T V <br />Water Meter: Fee S <br />Sewer Houcup: (City) Fee S <br />Install Plumbing Systems: Fee S <br />Instal Sewage Disposal Systems: Fee S Signa to a icant <br />Instal Water Hookup: (City) Fee $ LLLLLL <br />Install Water Supply Systems: (Wen) Fee S <br />i <br />SAC Fee S Signature of City offilial <br />Yo <br />State Surtax: Fee S <br />Total Amount Paid to City ......... Fee S <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold-Appncant's Receipt <br />