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City Permit N? 5438 <br />Contractor <br />!cz4 <br />Address <br />ice? l ei. l7Z- �c'oc,�Fouz <br />Owner <br />Address_S-C'3 <br />%J, G_GQNLI1ILE <br />State License No. <br />Parcel No. <br />Section No. Lot <br />Plat No. <br />Other Description: <br />—City License No. <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota <br />473 ?357 <br />Date 12 _ 78 <br />Block 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 />or S-r-pm- O e2 z_ a - T'a G, r Y <br />Water Meter: <br />Fee S <br />Sewer Hookup: (City) <br />Fee $ <br />Install Plumbing Systems: <br />Fee $ <br />Install Sewage Disposal Systems: <br />Fee $ <br />Install Water Hookup: (City) <br />Fee $ <br />Install Water Supply Systems: (Well) <br />Fee S <br />SAC <br />Fee S <br />State Surtax: <br />Fee S <br />Sigma urc of app ' an <br />l <br />V <br />Signature of City fficial r <br />�r <br />Total Amount Paid to Citv ... ..... Fee $ -�_ C) "— <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />