HomeMy WebLinkAbout1976-03-16 Permit, New Water Well #4343Contractor�' �' c? /a �G C / Add r -
Owner Address—
State
ddress
State License No
Parcel No.
Section No
Plat No
Other Description:
Village Permit N° 4343
Village License No //X 4
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Lot Bloom Subdivision
Date-
Parcel
ate
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 Village Code of Orono applicable thereto, and shall include all additional specifications as listed below.
Water Meter:
Fee S
Sewer Hookup:
Fee S
Install Plumbing Systems:
Fee S
Signature of applicant
Install Sewage Disposal Systems:
Fre S
Install Water Hookup:
Fee S
Install Water Supply Systems:
Fe: � 12ele-1
Install Sewer Hookup:
Fee S
Signature of Village Official
State Surtax:
lee S
Total Amount Paid to Village...........
Fre S