HomeMy WebLinkAbout1979-11-26 Permit, Septic SystemCity Permit N? 5829
Contractor L&)e.,, . A., 1: Address ,?�US' rY/1.� A
Owner k. , , " -) Address X96 .�� a1L ��• "� t�
State License No.
Parcel No.
City License No. _ __ _
GENERAL PERMIT
CnT OF ORONO
Crystal Bay, Nlinncsoi.i
473.7357 I).tt�•1i :�����
Section No. Lot _ Block Subdivision
Plat No.
Other Description:
I hereby agree that, in case a permit is granted, all wo.'• 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:
Serer Hookup: (City)
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup: Wity)
Install Water Supply Systems: (Well)
SAC
Fee S
Fee S
Fee $
Fee $D.
SiR turc of applicant �y
�� /`? v....✓t
Fee $
Fee $
1•ce S
State Surtax: Fee S a .�_V
Total Amount Paid to City ......... Fee S W • s�
Signature of City Official
Code: White -Fib Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt