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City Permit N? 5612 <br />Contractor Address <br />Owner Addresz 7 <br />State License No, <br />Parcel No. <br />City License No. <br />GENERAL PERMIT <br />CPl'Y OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 Date — <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 S <br />Sewer Hookup: (City) <br />Fee S 4p, H7 <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 $ <br />SAC <br />Fee $ <br />State surtax: <br />Fee S „ 7r0 <br />Total Amos!;a Paid to City ......... <br />Fee $ a*• -S"O <br />Signa ure%f a0ficant <br />Signat f City Official <br />Code, White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />