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Contractor 40,�� <br />Address <br />City Permit N? <br />Owner Ate,, Address / tV 6 <br />State License No. <br />Parcel No. <br />City License No. _ �a( �15 <br />GENERAL PERMIT <br />CITY OF ORONO <br />4946 <br />Crystal Bay, Minnesota <br />473.7357 C� /� z'z <br />Date / f <br />Section No. Lot Block <br />Plat No. <br />Other Description: <br />Subdivision <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 $ <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 $ <br />Install Water Supply Systems: (Well) <br />Fee $_ _ <br />SAC <br />Fee $ <br />State Surtax: <br />Fee $ <br />S� <br />Total Amount Paid to City . ... .... <br />. Fee $ <br />4tof ant <br />�1—_V_ <br />Signature of City Official <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />