HomeMy WebLinkAbout1973-09-04 Permit, Water Supply SystemVilla" PKmit 3775
Contractor,�66- Z�2 �2 .J� Address -)N
Owner_1jr1G�' I ^ r /� .�-L . Address ( =�` [ i4 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 GrLL— Z-- ?
1 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 -
Sewer Hookup:
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup:
Install Water Supply Systems:
Install Sewer Hookup:
State Surtax:
Fee S
Fee S
Fee S
Fee S Signature of applicant
Fee S
Fee S OJT ul%
Fee 5
Signature of Village Official
Fee 5 a J
Total Amount Paid to Village........... Fee $ 1,) -;r C)