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Contractor <br />Owner (I -7)^I 5 t,/ <br />State License No. <br />Section No <br />Parcel No <br />Plat No <br />Other Description: <br />Lot <br />Address <br />City Permit No <br />I • 1 <br />City License No. <br />GENERAL PERMIT <br />CNY OF ORONO <br />Crystal Bay, Minnesota <br />473-73$7 <br />Block Subdivision <br />Date /% <br />1 hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />Water Meter: <br />Sewer Hookup: f0ty) <br />Install Plumbing Systems: <br />Install Sewage Disposal Systems. <br />Install Water Hookup: (City) <br />Install Water Supply Systems (Well) <br />Fee S <br />Fee $ <br />Fee $ <br />Fee S <br />Fee S <br />Fee $ L(6 tw - n <br />Signal of applicant <br />� :J • r <br />SA(' For $ _ S <br />State Surtax Fee S _ •y.L�_�1 <br />I otal Amount Pod t.) City Fee S <br />.r Wtute-File Copy, Canary Inspector's ( op). Pink-Financv Copy: GoW-Apph, ant'. Receipt <br />