HomeMy WebLinkAbout1978-07-24 Permit, Water Well #5254City Permit _;0 5254
Contractor S-Tt, PoA a iJ E L -Lr Address /S 3 0�, HW y 7
Owner f ALLEX OULICQCC / Address/, I -Z1/4 ie ,7
State License No. City License No.
GENERAL PERMIT
C[TY OF ORONO
Crystal Bay, Minnesota
473.7357
Parcel No.
Section No. Lot Block Subdivision
Plat No.
Other Description:
I)ate % — 2-Y- %B
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.
b .�., _ TV*ML_- _ ____
Water Meter: Fee S
Sewer Hookup: (City) Fee S
Install Plumbing Systems: Fee S
Install Sewage Disposal Systems: Fee $ Signature of applicant .
Install Water Hookup: (City) Fee S
A
Install Water Supply Systems: (Well) Fee S
SAC Fee S St turd of( 1) fic
State Surtax: Fee S
'i Sfl L
Total Amount Paid tc City .. Pee S � V
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy. Gold -Applicant's Receipt