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City Permit <br />Contra, <br />Owner <br />State License No. City License No. <br />Parcel No <br />GENERAL PERMIT <br />CITY OF ORONO <br />Na 6471 <br />Crystal Bay, Minnesota <br />473-7357 <br />Date <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. f� <br />Water Meter: <br />Fee $ <br />Sewer Hookup: (City) <br />Fee $ <br />OD <br />Install Plumbing Systems: <br />Fee $ <br />Install Sewage Disposal Systems: <br />Fee $ <br />Install Water Hookup: (City) <br />Fee S <br />Install Water Supply Systems: (Well) <br />Fee $ <br />SAC <br />Fee S <br />State Surtax: <br />Fee % �U <br />Total Amount Paid to City ......... <br />Fe 10 0 to <br />Signat applicant <br />i� <br />Signatuty Vfficial — <br />t <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />