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city Permit N? 6540 <br />Contractor &La Address 3 <br />Own,-r / '►7�- 1� ��— Address `f' -'5 -d <br />State License No. City License No. <br />GENERAL PERMIT <br />Crff OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 <br />Date -A57 <br />Parcel No. <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: Fee S <br />Serest Hookup: (City) Fee S <br />Install Plumbing Systems: Fee S <br />Install Sewage Disposal Systems: Fee S _�� 5 . v� Sign::tyre Qf a t <br />Instal Water Hookup: (City) Fee S <br />Install Water Supply Systems: (Well) Fee S <br />SAC Fee S / /_ Signature t Ofticisl <br />_ ,l <br />State Surtax: Fee S • 5o <br />Total Amount hid to City ......... Fee S �_ 50 X <br />Code: White -Fib Copy; Chary -Inspector's Copy; INr once Copy; Gold -Applicant's Receipt <br />