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Contractor <br />Address <br />Ae <br />Owner ' ' l J Address- �� I Y <br />6W <br />State License No. C' L' N <br />City Permit jv0 4607 <br />Ity lcense V. <br />GENERAL PERMIT <br />CITY OF ORANO <br />Crystal Bay, Minnesota <br />473-7357 <br />Date <br />Parcel No. <br />Section No. Lot Block Subdivision <br />Plat No. <br />Other Description: <br />9--i�Z-766 <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />- :A-- 70 3 .27, <br />�74r?_:Z; - -4.1 a5 a s� 00i1 <br />Water Meter: Fee S 60.0c) <br />Sewer Hookup: (City) <br />Fee $ <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S <br />Install Water Hookup: (City) <br />Fee $ 1-6-0o <br />Install Water Supply Systems: (Well) <br />Fee $ <br />SAC <br />Fee S <br />Signature of applicant <br />1 <br />Signature of City Off' <br />State Surtax: Fee S <br />Total Amount Paid to City ......... Fee $ <br />Code: White -File Copy; Canary -Inspector's Copy; Pir.k-Finance Copy; Gold -Applicant's Receipt <br />