HomeMy WebLinkAbout1976-08-23 Permit, Water Supply System #4564Village Permit N° 4564
Contractor__.L!-E L`�'tb% L L� vI Address
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Owner C�rc' — -- - Address i , to F7
State License No
Village License
GENERAL PERMIT
VILLAGE OF C.-HONO
Crystal Bay, Minnesota
Date
Parcel No.
Section No Lot Block Subdivision
Plat No
Other Description:
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 S
_
Signature of applicant
Install Sewage Disposal Systems:
Fee S
Install Water Hookup:
Fee S
Install Water Supply Systems:
Fee S
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Install Sewer Hookup:
Fee S
Signature of V'llage O,fficia�
State Surtax:
Fee S
5
i{er' 5
;
Total Amount Paid to Village...........
Fee S