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Contractor Zyor y,��� <br />AW <br />Owner- �� �'r�` - , -- <br />State License No.._ <br />i) <br />_ Address_ ._ <br />_ Address.. <br />Village License No.; _ <br />Village Permi+ NQ 691 <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />CrNstal Bac, \linncsota <br />Of <br />Date <br />e L 4_� Lot—_ Lt Block <br />Section No. __ __ Parcel No. <br />__ _ - <br />Plat No.__. <br />Other Description: <br />I hereby agree that, in case a permit is granted, all <br />work which shall be done <br />and <br />all materials which shall be used. shall <br />comply with the Village <br />Code of Orono applicable <br />thereto, and shall include <br />all <br />additional specifications as listed below. <br />Install plumbing slsteuts: <br />.Las" <br />deposal systeuts <br />Repair <br />In+ta11 <br />Kelutir <br />I (mul atiMmut pail to S i A► i. <br />Fee $__ <br />f ec 5-.4�-tA <br />— <br />F cc S <br />1•rc S_._ <br />'ss0 <br />em.._ - <br />Signature of applicant <br />Stit>btturc t�f S itli�t tJ�cia) <br />L` r <br />