HomeMy WebLinkAbout1972-06-28 Permit, Water Supply Hookup #3178Village Permit
Contractor ,�'^ � � �1Lk4,4 dOL Address
Owner 4`1 c! U � 1 (Jt �c C Address �3 ��i 1 / 4-
State License No. _ Village License No
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Parcel No. --
Section No Lot Block Subdivision
Plat No.
Other Description:
Date /- - ,,� 4 7 Z
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.
Install plumbing systems: Fcc $
Install
sewage disposal systems: Fee $ —
Repair
Install ,c A �,
water sr4pply-•�' Fee $ziio
Repair
Fee $
Total amount paid to Village....... $
Signature of applicant
Signature of Village Official