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Contractor { t'' � Q Q Addres <br />Owner Address <br />State License No. Village License No <br />Parcel No. <br />Section No <br />Plat No <br />Other Description: <br />Village Permit ► ti <br />GE1� TRAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Lo+ Blocti Subdivision <br />3282 ,� .4 <br />Date /,1 4 /- "Y <br />I hereby agree that, in case a permit is granted, all work which shall be doge 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 />s <br />Install plumbing systems: FCC $— <br />Install <br />sewage dis: Fee $ <br />Repair <br />Install 5 Z <br />water sup-systew Fee <br />Rcpair - <br />Fee $ <br />Total amount paid to Village....... $ 1' <br />Signature of applicant <br />Signature of Village Official <br />