HomeMy WebLinkAbout4968 - wellCity Permit NO 4966
Contractor , st,, ri, Address
Owner �r r��:e �eln;Il1J i, Address �y�'� �c {1n 5 Pt %et
State License No.
Parcel No,
City License No
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473.7357 / 7 7
Date
Section No. Lot Block Subdivision
Plat No.
Other Description:
1 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: Fee $
Sewer Hookup (City) Fee $
Install Plumbing Systems: Fee S
Install Sewage Disposal Systems: I. cc $ Signature of applicant
Instal Water Hookup: (City) Fee $
cn
Install Water Supply Systems (M'ell) I ee S vZG_ _
SAC Fee S ltenature (uy (>fOciaI
State Surtax: Fee S
Total Amount Paid to City . .. . .. .. . Fee S -;'20_��
Code: Wkite-Flle Copy; Carimy•inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt