HomeMy WebLinkAbout1977-11-15 Permit, Water Well #5013Contractor e)"u JT' ("Q
Owner ij c -
State License No.
City Pemut N? 5013
Address �6 /�ixz z/e"e
Address l A4 5 X47
__City, License No.
GENERAL PERMIT
CM OF ORONO
Crystal Bay, Minnesota
473-7357
[)ate S
Parcel No.
Section No. _ Lot Block
Plat No.
Other Description:
Subdivision
hereby agree that, in case a permit is granted, all work which shall he 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:
Fee $
Sewer Hookup: (City)
Fee S
Install Plumbing Systema:
Fee S
Install Sewage Disposal Systems:
Fee S Signature -,I appik ant v
Install Water Hookup: (City)
Fee f
Go
Install water Supply Systems: (well)
i ee $ 'I1
SAC
Fee S Surest lty Uff��.
State Surtax:
Fee S 50
Total Amount Paid to City ....... Fee f C20 ,
Code: wldteF'iie Copy; Caney -Inspector's Copy; PWt-FfuoOw Copy: Gold -Applicant's Receipt