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PERMIT <br />CITY OF ORONO <br />1335 Brown Rd South • P.C. 3ox 66 <br />Crystal Bay, Minnesota 55323 <br />(612) 473-7357 <br />SITE ADDRESS: '24o <br />LCIT ; 004 <br />K.ELLEY' S <br />C`R T N:_ � } <br />FEE SUMMARY: <br />PERMIT TYPE: '--.EWER & WATER <br />Permit Number 000047 <br />Date Issued ()"/ I I / U <br />FOX ST <br />r-LOCK': 001 <br />LAND <br />c;ewer & Water Permit. TyRr WELL <br />Sewar & Water Work Type RESIDENCE <br />Erase Fee $ . 00 WELL .__-__-- <br />Surcharge ----------1-54- Total Fee $30 . S0 <br />Subtotal $.50 <br />CONTRACTOR: - Applicant - OWNER: ' <br />,. ILLCO 4972:3:34i► ti!HN: i iN JAMES <br />8790 HWY 12 E :::-'7 W E:USH LK RU <br />OELANO MN SS: 2:� :I M I NG TON MN <br />(612 ) '?72- _::40 '2'a-7;_E:0 <br />REMARKS: <br />(— THE UNOERSIGNEO HEREBY REQUEST PE: ION T4 MAKE THE REAL IMPROVEMENTS 1 <br />SPECIFIED AND AGREES TO DCs ALL WORK .3TRIC:T COMPLIANCE WITH ALL. CITY OF <br />L ORONO ORO I NANCES ANO STATE OF M I NNES►a TA BUILDING CODE REQUIREMENTS. <br />'tj <br />PLICANT PERMITEE SIGY• ISSU'"' 8i . SIGNATURE <br />