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7 7Y �t r" 1% 'Y 9 ?0 <br />City PermitN? 4971 <br />Contractor /(J�' X�_ Address <br />Owner 1.-.1.�c kS.nuJ Address cl �O �vtz EST �RnnS <br />State License No. City License No. <br />GENERAL PERMIT <br />CUY OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 <br />Date lo' 7-7/ <br />Parcel No. <br />Section No. Lot Block <br />Plat No. <br />Other Description: <br />Subdivision <br />6�' •v L° <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 S <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) Fee $ <br />Signature of applicant <br />SAC Fee $ Signatu of City off" 1 <br />State Surtax: Fee $ <br />Total Amount Paid to City ......... ee S D)o . A U�p Q V C LC' 6 R N/4 L CC). (,f L, S s e .CS c' Ag") <br />D/A is c rX To ,,ppC a K 4 t4 i0 y,(,q I A. iy yy PR& Se`k Ck — <br />Code: White -File Copy; Canary Inspector's Copy; Pink -Finance Copy; i3o�d5AppU'cant's Re�eip Srt rPlf'rd f o ; aAc TKO. �je 990 <br />