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Owner <br />State License N <br />Parcel No. <br />Section No <br />Plat No <br />Other Description: <br />10 <br />Village License N <br />GENERAL PE <br />VILLAGE OF Oh <br />Crystal Bay, Minnesota <br />Lot__—__- 131ock___— _ Subdirisiorn <br />Village Permil N° 1726 <br />J <br />Dat <br />1 hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall <br />comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />lnstall plumbing systems: <br />Install <br />Itcpair sciage disposal systems <br />I nstall <br />water supply systems: <br />Repair <br />J� C-, #'Lx— 10'r �71-� 1.) 0A <br />IS <br />Fee S_ __.____ Signature of applicant <br />Fee f <br />Fee b _ <br />Fee <br />Total amount paid to \ illage.... S__l.•- <br />Signature of Village Offrclal <br />