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3'v13c. r/ry r,Fs <br />. V6;aC-D P&Rgrr 77i <br />City Permit N? _ 4990 <br />1 � <br />L% ^1 /5 lV&IQIt9 j r S t�Bfi r jvJt! <br />C1 V e r _ <br />Contractor "Po (K� �4"' Address 7160 (.1.1, //o w Dr b rn 1. <br />Owners ' (-Z LlCk5C A/ Address T?-o Z0/dr_' t T AJ?ly <br />State License No. <br />Parcel No. <br />City Li :use No. <br />GENERAL PERMIT <br />CITY (1F OhONO <br />Crystal Bay, Minnesota <br />473-7357 Date l0 Vie ^ 7 7 <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 />s^�D <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 />Signre of applicant <br />SAC Fee $ Signat a of City Official <br />/ 7 <br />State Surtax: Fee $ <br />Total Amount Paid to City ........ Fee $ `% T NI S 7 V,4,4 SFG/Q40 -/QG'%1 /cEE P/%/U f �A <br />1ER�ir "tr'f197! •c r/rcfr cr.F s /iC`/'L-A1,01 a <br />Code: White -File Copy; Canary -Inspector's Copy; <br />Pink- nonce Copy; Gold -Applicant's Receipt G ARL l u 1V AJ.41P y /9G S s 04 S'o k <br />/0-21-77 ,2y1 <br />