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Contractor <br />Address <br />Owner- Address <br />Address <br />State License No. <br />Parcel No. <br />City Permit.N, ? 4864 <br />City License No. <br />GENERAL PERMI <br />CPl'Y OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 <br />Section No. Lot Block Subdivision <br />Plat No. <br />Other Description: <br />Date Z - % - 7 <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 )deter: Fee $ <br />Sewer Hookup: (City) Fee S� <br />Install Plumbing Systems: Fee S <br />Ir-tall Sewage Disposal Systems: Fee S Signature applicant t <br />Install water Hookup: (City) Fee S <br />ISKA water Supply Systems: (well) Fee S <br />SAC Fee S Signature of City Offic' <br />State Surtax: Fee $ t <br />Total Amount hid to City ......... Fee $ <br />Code: white -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />