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City Permit NO 4966 <br />Contractor , st,, ri, Address <br />Owner �r r��:e �eln;Il1J i, Address �y�'� �c {1n 5 Pt %et <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 / 7 7 <br />Date <br />Section No. Lot Block Subdivision <br />Plat No. <br />Other Description: <br />1 hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />Water Meter: Fee $ <br />Sewer Hookup (City) Fee $ <br />Install Plumbing Systems: Fee S <br />Install Sewage Disposal Systems: I. cc $ Signature of applicant <br />Instal Water Hookup: (City) Fee $ <br />cn <br />Install Water Supply Systems (M'ell) I ee S vZG_ _ <br />SAC Fee S ltenature (uy (>fOciaI <br />State Surtax: Fee S <br />Total Amount Paid to City . .. . .. .. . Fee S -;'20_�� <br />Code: Wkite-Flle Copy; Carimy•inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />