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City Permit I? 4849 <br />Contractor res s Address <br />Owner �"""'� ` Address 945 C �LC'Cze�CC-rt <br />State License No <br />Parcel No. <br />Section No. <br />Plat No. _ <br />Other Description: <br />C, v License No <br />GENERAL PERMIT <br />CnY OF ORONO <br />Crystal Bay. Minnesota <br />473-7357 _mac <br />Date r 2 % — <br />Lot Block Subdivision <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which 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 />Water Meter: <br />Sewer Hookup: (City) <br />Instill Plumbing Systems: <br />Install Sewage Disposal Systems: <br />Install Water Hookup: (City) <br />Install Water Supply Systems: (Well) <br />SAC <br />7s- o// <br />Fee S ©� <br />Fee S <br />Fee $ <br />Fee S Signature ant <br />Fee S <br />Fee S <br />Fee $ <br />State Surtax Fee $ 1 S <br />Total Amount Paid to City _ . . ... . Ice S <br />Signature 31 City Official <br />Code. White -Fie Copy: Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant'% Re,eipi <br />