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Contractor <br />Owner <br />GLS <br />Address <br />Address <br />State License No. City License No. <br />Section No. <br />Parcel No. <br />Plat No. <br />Other Description: <br />1V6 <br />City Permit 4 <br />0 <br />GENERAL PERMIT <br />CM' OF ORONO <br />Crystal Bay, Minnesota <br />5536 <br />P, <br />473-7357 Date Y—ZV- <br />7�1 <br />Lot _ Block Subdivision <br />s.Cc- <br />�17 -Z3 <br />S0 N w SW <br />I -- <br />I hereby agree that, in case a permit is granted, all work which shall a d<�ne and all materials whish 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 />e <br />Water Meter: <br />Sewer Hookup: (City) <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 />l-ee S <br />d�O <br />FCC S -- <br />SAC 1ccS <br />State Surtax.- <br />Total <br />urtax:"Total Amount Paid to City . . . . . . . . . Vee S ' <br />-Sr�r�at� a -►1 i i�ir� ;,nt <br />Signature of City Offici�l <br />�1 i� <br />('.)de: White; -bile Copy -1 ( anary-Inspector'% ( opy .- Pink+inance Copy, hold -Applicant's Recertl, <br />