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Village Permi! N° 1969 <br />Contractor + ` al Address_ <br />Owner_,...e)G & r.te�__ <br />State License No <br />_—_ Village License No. _. . <br />GENERAL PERMIT <br />VILLAGE r r "RONO <br />Crystal F <br />Dat / <br />Parcel No. <br />Section No Lot__. _ M mk__ _ lbdivision_ <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 used, shall <br />comply with the Village Code of Orono applicable Ihcreto, and shall include all additional specifications as listed below. <br />Install plumbing systems: Fec <br />Install <br />,term sewage disposal systeuu: Fee <br />,install � �� <br />water supph .%stems: Pec `by�_ <br />Repair <br />--- _._ Hee s__ - — <br />/Z� <br />`I'utal amount pond to \ illagc. S.1'f <br />Signaturc of applicant <br />`signatntc 0 \ 1I1age Officul <br />d � t/ <br />'r <I L irr7--�--J <br />