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a• S .a. its-:qp ..N+. i:.�NYf r ln" <br />Contractor_ / � Addrese <br />Owner_ e 1/l Q-j(,1A e / , Address F <br />Statc Licensc No. Village License No <br />Section No <br />Parcel No. <br />Plat No <br />Other Description. <br />0 <br />Ville" Pena 3727 <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Lot Block Subdivision <br />Date `/ ✓ — <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 thereto, and shall include all additional specifications as listed below. <br />_ 1 C 'a — <br />Water Meter: Fee S <br />Sewer Hookup: <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sew•.I,c 11, 1`.�sai Systems: <br />Fee S <br />Instal: Water Hookup: <br />1 <br />Fce S C L' <br />Install Water Supply Systems: <br />Fee S <br />Install Sewer Hookup: <br />Fee S <br />Stat, Surtax: <br />Fee S / ' n 67 <br />Total Amount Paid to Village...... <br />Fcc S� <br />Signature of applicant <br />Signature of Village Official <br />� � i <br />J <br />