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City Permit-f 0 4881 <br />Contractor Address _ <br />Owner 9A44_z ' AddressR— <br />State License No. <br />Parcel No. <br />Section No. Lot <br />Plat No. <br />Other Description: <br />City Licensc No <br />GENERAL PERMIT <br />CITY OF OR,ONO <br />Crystai Bay, Minnesota <br />473-7357 Date_ <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 />Water Meter: <br />I ee S <br />Sewer Hookup: (City) <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S Signature of applicant <br />Install Water Hookup: (City) <br />Pee S -- <br />Install Water Supply Systems: (Well) <br />Fee $ <br />SAC Fee S Signature of Cit IOfFi <br />State Surtax: Fee t L <br />Total Amount Paid to City .... .... . Pee $ S� <br />Code: Wldte-File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />I <br />