HomeMy WebLinkAbout1977-06-01 Permit, Water Well #4814CiiyhmiltN? 4814
Contractor^
Owner (3^
/yU(^
State Uccnie No..
. Address
. Address
.City License No.
♦1
- /-
GENERAL PERMIT
ary of orono
Crystal Bay, Minnesota
473-7357
Parcel No-------
Section No--------------------Lot.
n-Date.
. Block..Subdivision.
Plat No.
Other Description:
m
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 Qty Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
\
WaftrMtttr:
Smr Hookup: CCIty)
teftoaniMibiivSyilHM:
fauia Sawage Disposal System:
Instal Water Hookup: (City)
InstaB Water Supply Syitcim: (WeU) Fee S
SAC Fee $_______
State Surtax: FeeS _____
Feel.
1 Fees.
Fees.
Fees.
Fees.f'
Signature of Gty OlHcial
ToUIAnoiulPddtoaty...................Fwl
0)4.; «Ml.Fa. Conr;Cnuiy-Iiii|wctor ‘k Copy:Plak-Fiiiiiic. Copy; Gold-Appllam'i Rwdpt