HomeMy WebLinkAbout1978-06-07 Permit, Water Well #5186City Nrmit.l0 5186
Contractor STft=j/eAyS WELL- Address &W« h -4//U
Owner 1T��j�_ik �me_Scv�) Address '196s— goT Inez
State License No,
Parcel No,
City License No,
GENERAL PERMIT
CITY OF ORONO
Crystal Bay. Minnesota
473-7357 i 7A
Date
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 u%ed,
shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
C o r r c+ F s rAllo L JE7LW=EZooM P -J. LCT— BE; s�-ntT •ra r_ 1 T V
Water Meter: Fee S
Sewer Houcup: (City) Fee S
Install Plumbing Systems: Fee S
Instal Sewage Disposal Systems: Fee S Signa to a icant
Instal Water Hookup: (City) Fee $ LLLLLL
Install Water Supply Systems: (Wen) Fee S
i
SAC Fee S Signature of City offilial
Yo
State Surtax: Fee S
Total Amount Paid to City ......... Fee S
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold-Appncant's Receipt