HomeMy WebLinkAbout1978-08-25 Permit, New Water Well #5292CityNrmitN? 5292
Contractor S= pD L,%} Address %S 30 6 iAj Y %
p � ! I
Owner 1� JDE2IGk L 1>2 9, Address % yy /J • SACO WA) P, -
State License No.
Parcel No.
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473.7357 Date ° Q
- 2_1Y _?
Section No. Lot Block Subdivision
Plat No.
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 City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
Com y 0,0c�- s-rtV_TZ- t -'E7 -Z LZ z ,Pb rn&4-tT 86- sN6r-.l 7rT":b .
Water Meter: FCC $
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee $
Install Water Hookup: (City)
FCC S
Install Water Supply Systems: (Well)
Fee S
SAC
Fee S
S"D
Stat: surtax:
Fee S
_
2O— r
Total Amount Paid to City .........
I cc S
-Fignatuy of applicant
si • tur�wt C'ty ),ri
Code: White -File Copy; Canary•lnspector's Copy: Pink -Finance Copy: Gold- Applicani's Receipt