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City Permit N? 6460 <br />Contractor iNIZZ e�4 Address <br />Owner vs Address��������Gc.c� <br />State License No. _ City License No. <br />GENERAL PERMIT <br />CITY OF Ori0N0 <br />Crystal Bay, Minnesota <br />473-7357 <br />Date <br />Parcel No. <br />Section No. Lot _ Block Subdivision <br />Mat No. <br />Other Description: <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: <br />Fee S <br />Sewer Hookup: (City) <br />Fee $ '2t7 <br />Install Plumbing Systems: <br />Fee S <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 />pe <br />Fee S_ <br />s� <br />State Surtax: <br />Fee $ <br />Total Amount Paid to City . . . . ... . Fee S A!a_ 3v <br />Signat�Ofappl'nt9-� <br />Signature of City Of ial <br />�� C " <br />i <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />