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City Permit No 5143 <br />Contractor 1 a /Z_ Al e&l Address <br />Owner Address :D h �Q <br />State License No. <br />Section No. <br />Parcel No. <br />Plat No, <br />Other Description: <br />City License No. <br />Cl�`NERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 S 78 <br />Date <br />Lot Block Subdivision <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 />S.4 C 2 Fe��ZVIZ- -2 7Z- s <br />A Mop I s - 7 3 <br />Water Meter: Fee S <br />u� <br />Sewer Hookup: (City) Fee S 2o. <br />Install Plumbing Systems: Fee $ <br />Install Sewage Disposal Systems: Fee S Signature of applicant <br />Install Water Hookup: (City) Fee $ v e <br />Install Water Supply Systems: (Well) Fee $ <br />SAC Fee $ i nature o City Officia <br />State Surtax: Fec S s6 <br />Total Amount Paid to City ......... Fee $ �Q ' <br />Code: White -File Copy; Canary -inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />