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Village Permit 11 ' 5 .2
Contractor__ ' Address
Owner"n�J C Address
State License No. Village License No
GENERAL PERMIT
Parcel No._
Section No
Plat No
Otter Description:
VILLAGE OF ORONO
Crystal Bay, Minnesota
Lot Block Subdivision
Dat,
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 Village Code of Orono applicable thereto, and shall include all additional specifications as listed below.
Water Meter:
Fee S
Sewer Hookup:
Fee S z x
Install Plumbing Systems:
Fev 5
Install Sewage Disposal Systems:
Fee S
Install Water Hookup.
Fee $
Install water Supply Systems
Fey '.1 —
Install Sewer Hookup
Fee S
State Surtax:
Fee S 40
Total Amount Paid to Village I . Fre S / r " Y r
Signature of applicant
Signature of Village Official
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