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City Permit N 9 6397 <br />Contractor EA�C_L .�'�1 4 S ti! Address W h LA <br />Owner L( `1 t? Address <br />State License No. <br />Parcel t1o. <br />City License No <br />GENERAL PER,oIIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota -2 k2 <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. <br />Water Meter: <br />Fee $ <br />Sewer Hookup: (City) <br />Fee $ 1-1_ <br />Install Plumbing System ,: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S <br />Install Water Hookup: (City) <br />Fee S <br />Install Water Supply Systems: (Well) <br />Fee $ <br />SAC Fee S 42 S-, 00 <br />State Surtax: Fee $ 1 tQ <br />Total Amount Paid to City . .. . .... . Fee $ _ S-0 <br />Code: White - File Copy; Canary Ins)xctor's Copy; Pink -Finance Copy; Gold-Apalic__._ <br />Signature of applicant <br />