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Village Permil N! 1489 <br />Contractor ---=-�� ���'L_ Address <br />Owner_ /Q � Pik .----- .Address <br />State License No._____ _ _—_ ___ ___ Village License No. <br />GENERAL PERMIT <br />Parcel No. <br />Section No <br />Plat No <br />Other Description: <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Lot Block--_ Subdivision_ <br />Date <br />I hereby agree that, in ease a permit is granted, all work which shall be done and all materials which shall be used, shall <br />comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />Install plumbing systems: <br />Install <br />Repair sewage disposal systems <br />Install <br />Fee S— -- Signature of applicant <br />Fee _ <br />Repair r supply systems: Fee b _ <br />—_ _ Fee �— <br />Total amount paid to Village........ <br />Signature of Village 1161 1 <br />