HomeMy WebLinkAbout1977-11-23 Permit, Water Meter #5021City Permit N8 5021
Contractof ''� `� " Pik .l O ZI Address Ltd S O / [ �c�t i `�" , / -S lPge `,` `�
Owner ram+.-,,/ j ,�t,, Address 3
State License No.1 Yc' q /1i City License No.
Parcel No.
Section No.
Plat No. _
Other Description:
GENERAL PERMIT
Cl'i'Y OF ORONO
Crystal Bay, Minnesota
473-7357 % Date �1 3
_
Lot 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 City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
ei
Water Meter:
Fee S
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee S
si lure of op licant
Install Water Hookup: (City)
ryi i') 1
Fee S
Install Water Supply Systems: (Well)
Fee $
SAC
Fee $
Signirttirc of City Official
State Surtax:
Fee f 0 •�' =� •
� '' --i� 1 �4'= f'
Total Amount Paid to City .........
Fee S 1 �l
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Cold -Applicant's Receipt