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City PermitN? 4959 <br />Contractor Address / <br />Owner Address <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 />473.7357 �` n _ <br />Date a�� Z-_C- <br />Block Subdivision <br />1 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: Fee $ <br />Sewer Hu kup: (City) Fee $ <br />Install Plumbing,, stems: Fee $ <br />Instsll Sewage Disposal Systems: Fee $ .w_ Signature of applican <br />I 1 / <br />Install Water Hookup: (City) Fee S -- -- <br />Install Water Supply Systems: (Well) Fee S _ <br />SAC Fee $ Signature (it City Official <br />O <br />State Surtax: Fee S <br />Total Amount Paid to City ... ... Yee S n <br />Code. White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />