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City Permit N? 6269 <br />Contractor sy: t!r GZ - ZC1�7 Address <br />Owner Lc t _ Address <br />State License No. <br />Parcel No. <br />Section No. Lot <br />Plat No. <br />Other Description: <br />City License No. <br />GENEKAL PERMIT <br />CITY OF MONO <br />Crystal Bay, Minnesota <br />473-7357 <br />Date dd <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 />Fee S <br />Sewer Hookup: (City) <br />Fee $ _ <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Install Water Hookup: (City) <br />Fee S <br />Fee S <br />Signature of applicant <br />Install Water Supply Systems: (Well) <br />Fee S <br />SAC Fee S Signature of Cit Ic j <br />State Surtax: Fee $ 5 C, % ------- <br />I s- L <br />Total Amount Paid to City . .. . . .... Fee S +"�� <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />