HomeMy WebLinkAbout1976-12-13 Permit, New Water Well #4724City Permit X?4724
Contractor
Owner___
Address
Address
State License No.City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
. f*Date
n- im i Parcel No.
Section No.Lot Block Subdivision >1
IV
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 used,
shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
Water iMeler:
Sewer Hookup: (City)
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup: (City)
Install Water Supply Sy stems: 0^'cll)
SAC
State Surtax:
Total Amount Paid to City ...........
Fees
Fee $
Fee $
Fee $
Fee $
ignature of applicant / VMlT
Fee $ , ^‘0
I ee $
Fee $5'^
...................Fee S exf/ ■
Code: White FUc Copy ; Canaxy-Inspcctor*s Copy; Pink-1-inance Copy; Gold-Applicant ’s Receipt