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Contractor f� L L/ E N '_:5 UJ E L L ' _ Address <br />Owner <br />State License No. <br />Parcel No. <br />Section No._ Lot <br />Plat No. _ <br />Other Descrip'ion: <br />City PermitN? 4917 <br />Address ' n <br />City License No. <br />GENERAL PERMIT <br />CM OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 <br />Block Subdivision <br />Date ,3 — �2_3 —77 <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 />Water Meter: <br />Fee S <br />Sewer Hookup: (City) <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fcc S <br />tii net applicant <br />Install Water Hookup: (City) <br />Fee S <br />• V� `� <br />Install Water Supply Systems: (Well) <br />Fee S_ <br />SAC <br />I ce S <br />Si City O(ft. <br />State Surtax <br />Fcc S , JD <br />,K -e) <br />Total Amount Paid to City . .. . Fee S LAU <br />Code: White -File Copy, Canary-Inspectur's Copy: Pi,ik-Finance Copy: Gold -Applicant's Receipt <br />