HomeMy WebLinkAbout1965-12-03 Permit, Well Repair #1009Village Permit N2 1009
Contractor<)
Address__
OwnL'L iL t ------ Address ';�L 4T-_
State License No. — ___�_ Village License Na.
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
i)atc
Parcel No._#�.., ^
Section No. — Plat No.4(.1L-2..a_ Lot_ /4— Block_ - Subdivision
Other Description: t
1 hereby agree that, irr case a permit is granted, all work which shall be done and all materials which shall be used, shall
comply with the Village t;ode of Orono applicable thereto, and shall include all additional specifications as ;isted below.
Install plumbing systems: lace
Install
sewage disposal systems: Fee
Repair
Install
water supply systems: l"cc g _
Repair
~7 Fee
Total amount paid to Villagc....... $ .a _
Signature of applicant
Signature of \'illagc Official