HomeMy WebLinkAbout1981-07-31 Permit, Water Well #6405City Permit N? 6405
Contractor `SI—ek-41 / 4 J e`�W ? Address AIIAL AW
Owner ' / Address
State License No,
Section No,
Parcel No.
Plat No.
Other Description:
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota /
473-7357 Date
Lot Block Subdivision
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 Mater:
Fee S
Seger Hookup: (City)
Fee S
[RUA Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee $ Signature of rpplkant
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well) Fee S �Ll�D
SAC Foe S of Ckty wicW
State Surtax: Fee $
Total Amount Paid to City ....
..... Fee
Code: WMte-File Copy; Canary -inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt