HomeMy WebLinkAbout1978-08-10 Permit, New Water Well #5274City Permit N? 5274
Contractor Address
Owner Address---,
State License No.
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357 C A _
Date �1
Parcel No. _
Section No. Lot Block Subdivision
Flat 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 City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
Water Meter:
Fee $
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee S
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
Fee $
tc gnaturepf 1i nt
SAC Fee $ Si at ity Official
State Surtax: Fee $
Total Amount Paid to City . ..... .. Fee $ vZ0 =s
Code: White•Fde Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt