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Contractor <br />Owner D i0 " � M <br />State License No, <br />Parcel No. <br />City Permit N? <br />Address <br />N c L_ So Address A 0'31D � D <br />City License No. <br />GENERAL PERMIT <br />CITY OF ORONO <br />4708 <br />Crystal Bay, Minnesota <br />473-7357 <br />Date <br />Section No. Lot Block Subdivision <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, <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 />Fee S <br />Signature of applicant <br />Install Water Hookup: (City) <br />Fee $ <br />,---,,,:-Aj,,._ <br />Install Water Supply Systems: (Well) <br />Fee $ <br />SAC <br />Fee S J �O. D O <br />Signs o t yypff�icia, ll <br />State Surtax: <br />Fee S <br />Total Amount Paid to City ......... Fee $ 3`sn • O n <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />