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ti <br />L t <br />,%llage Permit <br />Contractor Address l � A -A/ <br />Owner. %Address <br />State License No. Village License No <br />GENERAL PERMIT <br />VILLAGE OF ORf��4.0 <br />3530 <br />Crystal Bay, Niinnesota <br />t. <br />Date <br />Parcel No. <br />Serhon Nn-- Lot Block- Subdivision <br />Plat No <br />Other Description: <br />I hereby agree that, in case a permit is granted, 211 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 />7 <br />71std,1 Plumbing systems: Fee $ Signature of applicant <br />Install <br />sewage Fee $ /C <br />rMoir <br />Install <br />water supply systems: Fee <br />Repair <br />Fee $ <br />Total amount paid to Village....... <br />Signature of Village Official <br />I 4e- <br />a <br />