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City Permit N! 6570 <br />Contractor Lt uT N N E(L W E (_C_ Address t AD'r l a Mtn <br />Owner M - N4wimr�2 Address / AQ5 E(-P"6y4004 <br />State License No. 1. ifl 12S City License No. <br />GENERAL PERMIT <br />CPl'Y OF ORONO <br />Crystal Bay, Minnesota <br />473.7357 <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: <br />Fee S <br />3ewer Hookup: (City) <br />Fee S <br />In Plumb stems: <br />Install � Sy <br />Fee S <br />lastall'Sawwp Dupoal Systems: <br />Few $ si/itture of applicant <br />Install Water Hookup: (City) <br />r% p' <br />Fee S T/r /L/ �!J /i.y <br />lama water Supply Systems: (well) <br />0 <br />Fee S �• <br />SAC <br />Fee S 'ty official <br />State Surtax: <br />Fee $ .5-0 <br />Total Amount Paid to City ......... <br />Fee S ob• So <br />Code: wblte-File Copy; Canary -inspector's Copy; rink -Finance Copy; Gold-Apphcant's Receipt <br />