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City Permit ) © 632f, <br />Contractor 6Ai L �lN S?ft5 _ Add.e:s L o"e, LA KE <br />Owner 07AQ ZDv I r— _ Address J4 L �OR L C <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 01r 0110NO <br />Crystal By , Minnesota <br />473.1357 j <br />Date <br />Block Subdivision <br />I hereby agree that, in case a permit is granted, all work which shall be done. and all material, 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 />sAC_ Pd TS.- P. 3191 111617,6 <br />Water Meter: <br />Fee S <br />Sewer Hookup: (City) <br />00 <br />Fee S 20, <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 />h <br />Fee $ 5 (.' <br />Total Amount Paid to City . ... .... <br />. Fee $ '20. So <br />Signatutc of nplic i t <br />Si matu • �,f City Ofti a1 <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />