HomeMy WebLinkAbout10-12-1976 Permit, Water Well #4645City Permit N?1645
Contractor..Address.
Ownpr
State License No..
AHHre«
City License No..
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
A12-12S1 Date.
Parcel No---------
Section No------------------Lot.
Plat No_______
Other Description:
Block.. Subdivision.
I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used,
shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
Water Meter:
Sewer Hookup: (City)
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup: (City)
Fee $
Fee $
Fee $
Fee $
Fee $
Install Water Supply Systems: (Well)Fees JO.DO
SAC FccS
State Surtax:Fees •S'o
Total Amount Paid to City ...............
Signature of applicant A__d/
V
Code: White-File Copy; Canary-Inspector’s Copy; Pink-Finance Copy; Gold-Applicant’s Receipt