HomeMy WebLinkAbout1967-07-19 Permit, Water Well Repair #1678Village Permit Ne 1 678
Contractor '`�lL���Address
Owner_ t�� Z Address- ([ ( """4' f /
State License No.
Parcel No.
Section No—
Plat No
Other Description:
Village License
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Dat
Lot—_ Block SulAivisiun___._._
1 hereby agree that, in case a permit is granted, all word: which shall be done and zill materials which shall be used, Shull
comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below.
Install plumbing systems:
Install
Repair scwage dispxwsal systems
Install
do
supply systems:
o pai
c
Fee S—
F ec
Fec $
t' cc _
Fee 5—
Total amuumt paid to Village........ 5_—_ ._
Signature of applicant
Signature of Village Official