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r <br />Vil»9« P«nnil N* 20t1 <br />Cootnctor.“fc C ^dL fd i,t ( 4ai^. jyif. yi 'ria ' /^yi // <br />Owoet.C) [4/t /Aa *n^c 4Aiwi.« O '! ^ ^\f...^ T~r^ <br />State Lksme No. <br />r <br />Villi|e License No. <br />GENERAL PERMIT <br />VILLAGE OF OBOMO <br />Ciystal Bay, Mignoots <br />Seclioa No. <br />Fined No.. <br />Pbt No — <br />Block.Subdivision <br />Other DtKxi|itioii: <br />I hanbjr agree that, in ease a permit is granted, all work wUdi shall be done and all materials which shall be used, shall <br />comyljr widi the Village Code of Otono applicable thereto, and shall include all additional specifications as litled bdow. <br />4 <br />Install phimbmg r'tcnu:Fees.Signature of applicant <br />InstaU <br />Hicnair <br />('^tajp <br />>0—— <br />sewage disposal ssstcins: Fee $. <br />,*!:^ter supply ssstcins: Fee % <br />Repair <br />Fee %. <br />^ Total amount paid to Village ............5-4^ 0 I <br />Signature of V'illagc Qficial <br />M)z£c dsL^d/cA