HomeMy WebLinkAbout1976-09-27 Permit, Sewer & Water Hookup #4623City PSimit N9 4623 i
Contractor.
Owner___
s.Address
Address.
State License No. City License No.
GENERAL PERMIT
CITY OP ORONO *•
Crystal Bay, Minnesota
473.7357
Date 9-S7-7^
Parcel No.
Section No. Lot Block Subdivision
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 Meter:Feel ^ ^0
Sewer Hookup: (City)Fees ^ 0
InttaU Plumbing Sy items:Fee S
Install Diqwttl Syitemi:Fee S
Install gfister Hookup: (City)Fees
Install Water Supply Systems: (Weil)Fees
SAC Fees
State Surtax:Fee 1 //
Total Amount Paid to Gty................ . Fee S OQ j
Signature of applicant
Code: White-File Copy;Canary-Inipcctor’i Copy ; Pink-Finance Copy; Gold-Applicant'i Receipt