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Contractor <br />Owner <br />State License No. <br />Parcel No. <br />Section No. Lot <br />Plat No. <br />Other Description: <br />City Permit N? 6566 <br />Address <br />Address <br />City License No. <br />GEN jRAL PERMIT <br />C1 0V ORONO <br />Crystal Bay, Minnesota <br />473-7357 //, / f-,�� <br />Date <br />Block Subdivision <br />I 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 />-#*' k. 43 q- ,? .-- <br />/_, <br />Water Meter: <br />Sewer Hookup: (City) <br />Install Plumbing Systems: <br />Install Sewage Disposal Systems: <br />Install Water Hookup: (City) <br />Install Water Supply Systems: (Well) <br />SAC <br />State Surtax: <br />Total Amount Paid to City . .. . . .. . <br />Fee S <br />Fee S <br />Fee $ <br />Fee S <br />1: ee $ <br />Fee $ <br />Fee $ /��Le A� <br />Fee S s �' <br />Fee $ <br />Si t re of appli - nt <br />Signature of City Offic' <br />Code: White -File Copy; Canary -inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />/1, <br />