HomeMy WebLinkAbout04-13-1976 Permit, Water Well #4362village Permit N? _ 4362
Contractor Pr,//i?iP Addr
Owner.Addres:, /:^9a
State License No.^'72^4 __________Village License No
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GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Date./3-
Section No.
Parcel No.
Plat No-
Block-Subdivisic
Other Description:
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 Vilhgc Code of Orono applicable thereto, and shall include all additional specifications as listed below.
Water Meter:
Sewer Hookup:
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup:
Install Water Supply Systems:
Install Sewer Hookup:
State Surtax:
Total Amount Paid to Village...
Fees___________
Fees___________
Fee S____________
Fee $____________
Fee S ■ ___
n....
Fee $___________
Fee S_____<
Signature of applicant
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Signature of Village Official