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Q. ■\ X. <br />Village Permit N5 754 <br />a2;Conhapfflr Q <br />Owner <br />^^'Utryir-\ 1^' ■'1^AftHress <br />i :j^11^-k Add mss *2- 6 ^ <br />r <br />\ <br />State License No» <br />r’^ <br />»■ ••lr^ <br />1‘' <br />uv <br />a (/ i'a ^/? y ^ <br />Village License No. <br />GENERAL PERMIT V <br />sT 'X'> •, : .Vr- <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Date. <br />t;_. <br />t ’ <br />$/s/£'^■f <br />Section No.-^^,Parcel No.. <br />Plat No.- <br />Lot__inj-_ Block—/___ Siihflivisinn ^ <br />Other Description: <br />■(<“ <br />\ 1 'I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall <br />comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />y- <br />I'. <br />/v' r <br />'ir A ' *, <br />Install plumbing systems:Fee $.Signature of applicant <br />Install sewage disposal systems: l*’cc $. <br />Repair <br />Install ,water supply systems: <br />Repair <br />I’cc $. <br />Signature of Village Official <br />'I'otal amount paid to Village.......... 5. <br />. -4 <br />•.. 1