HomeMy WebLinkAbout1974-04-30 Permit, Water Supply #3902Village Permit N° 3902
Contractor ' __. i ,� Address
Owner �2 z, { . �4 Address
State Licensc No. Village License No
Parcel No.
Section No
Plat No.
Other Description:
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Date—
"ot _ Block Subdivision
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
Install Plumbing Systems:
Fee 5
Install Sewage Disposal Systems:
Fee S
Install Water Hookup:
Fee S
Install Water Supply Systems:
Fee S ZL)
Install Sewer Hookup
Fee S
State Surtax:
Fee S
Total Amount Paid to Village.. ........ Fee S
Signature of applicant
Signature of Village Official
61 L