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<br /> ' r�'� Vi�lage Pc�rmit N4 21 � 0
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<br /> Contractor ������ ��� ' ' ��'
<br /> Address
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<br /> Owner ` Address � J�� 5✓ l�e�
<br /> State License No Village Licensc 1\'0
<br /> 4,,: ;`::'� GEN�RA�. �'ERNIIT
<br /> _���..� VILLAGE OF ORONO
<br /> � �::
<br /> � Crystal Bay, Minncsota
<br /> Datc -� ��^ -� `j �
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<br /> �p�h� Parcel No
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<br /> "a'`�"�';�'� Section No Lo�_ Block Subdivision
<br /> .-:;�r.y,
<br /> Yi�._.
<br /> " F` Plat No
<br /> Other Description:
<br /> I hereby agree that, in case a pennit is granted, all work which shall be donc and all materiais which shall be used, shall
<br /> comply with the Village Co�ie of Orono applicable thereto, and shall include all �dditional specifirations as listed below.
<br /> / c—�G,� -�—�-_
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<br /> �c-�C � �..� /�- ,�'��
<br /> Install plumbing ��steins: Fee q Signature of applicant
<br /> - Install
<br /> sewage disnosal systems: Fec $
<br /> Repair —
<br /> Install
<br /> �•rater supp] systen:s: Fee �__
<br /> 5 � '„�2. Repair � � / Signature oE �'illag; Official
<br /> ' ��`•`� /!^'� Fec 5�� � ' �/ .��
<br /> $ ,�: _ � �_ �I �I�`-K-�— " l��°��
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<br /> ,=w , T�;tal amount Fxiid to Vilie�e....... _ �.
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