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City Permit No 5278 <br />Contractor (1V�K— Address <br />Owner i % Q.� �p�f/� Address l <br />State License No. <br />City License No. <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 <br />Parcel No. <br />Section No. Lot Block Subdivision <br />Plat No, <br />Other Description: <br />Date— 7J' <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 $ <br />Install Plumbing Systems: <br />Fee $ <br />Install Sewage Disposal Systems: <br />Fee $ <br />Install Water Hookup: (City) <br />Fee $ <br />Install Water Supply Systems: (Well) <br />oU <br />Fee $_ <br />SAC <br />Fee S <br />Signature of applicant <br />Signatt 71 City Official <br />State Surtax: Fee $ S� <br />Total Amount Paid to City ......... Fee S 17� G G�) <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />