HomeMy WebLinkAbout1976-10-26 Permit, New Water Well #4666City Permit INN. 4666
ContractorJ&Xe,�s Address
Owner ��''J��''� Address c7lS "'�a•
State License No.
Parcel No.
City License No,
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Section No. Lot Block Subdivision
Plat No,
Other Description:
Date /O " ,�6 -- 76
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.
Water Meter:
1•ee S
Seaver Hookup: (City)
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fec S plicact
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well)
Fee S —fO, 00
SAC
Fee S Sign urc (''t(7 )fficial
State Surtax:
Fee S
Total Amount Paid to City . .. . . . ..
. Fee $
Code: White -File Copy; Canary -inspector's Copy: Pink -Finance Copy. Gold -Applicant's Receipt