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City Permit Na 6580 <br />Contractor t i L L S'Tt.' 13m� Address <br />Owner d✓LLk S gik LG A420 Address _M3� F A- rr` •aKC- <br />State License No. <br />Parcel No. <br />City License No. <br />GENERAL PERMIT <br />!� QF 0110No <br />Crystal Bay, Minnesota <br />473-7357 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 />TJrvt <br />0 <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 />Install Water Hookup: (City) <br />Fee S <br />Install Water Supply Systems: (Well) <br />Fee S <br />Signature ofap�eNean <br />SAC Fee S Signature of City <br />State Surtax: Fee S <br />sz . <br />Total Amount Paid to City ......... Fee S " <br />Code: White -File Copy; Canary -inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />