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City Permit IN? 5005 <br />Contractor <br />SU L (•I <br />lhN t 'S 5E1ZU15,1'_ <br />Address Lk)At <br />ZAM <br />�j SS35 / <br />Owner <br />Address 30 `I / <br />FAIZV I EW <br />LANE <br />State License No. City License No. <br />GENERAL PERMIT <br />GTI'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 />Date // " Y' — 77 <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 />Instal! Sewage Disposal Systems.- <br />Fee $ 0 <br />Install Water Hookup: (City) <br />Fee S <br />Install Water Supply Systems: (Well) <br />Fee $ <br />SAC <br />Fee $ <br />Stele Surtax: <br />Fee S 5� <br />Total Amount Paid to City ......... <br />Fee $ .50 <br />re of app <br />t <br />Signature of City Official <br />r_7M,dJ Ot- <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />