HomeMy WebLinkAbout1978-10-13 Permit, Septic System Addition #5364City Permit _N? 5364
Contractor eL+y+•sx so A, �+_ C . Address SPRiNr AP_K_
Owner I-14+ARD PEreEXLsoA! Address 19VO C0064nu. RN_
State License No.
Parcel No.
City License No.
GENERAL PERMIT
C1TY OF ORONO
Crystal Bay, Minnesota
473-7357
Section No. Lut Block Subdivision
Plat No,
Other Description:
Date /0-12 -713
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 City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
Water Meter:
Fee f
Sewer Hookup: (City)
Fee S
InstaU Plumbing Systems:
Fee S
Instal Sewage Disposal Systems:
�.o
Fee S
Signature ant
Instal Water Hookup: (City)
Fee S
Install Water Supply Systems: (Wel)
Fee $
SAC
Fee $
Signature of City Official k
-
State Surtax:
Fee $
OL
Total Amount paid to City ... . .....
Fee $
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt