HomeMy WebLinkAbout1974-01-14 Permit, Water Supply System #3852Village Permit = 3852
Contractor ✓ ��—�YL� ��—� Address
Owner J A-21� 4 Jli i- ,., l L l Address
State License N
Parcel No
Section No
Plat No
Other Description:
Village License No
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Lot Block Subdivision
Date /— /'/ — if
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.
`'ater Meter:
Scu er Hookup:
Inst ill Plumbing Systems:
Install Sewage Disposal Systems.
Instill Water Hookup:
Install Water Supply Systems:
Install Sewer Hookup:
Fee S
Fee S
Fee S
Fee S Signature of applicant
Fee 5 / �
Fee S
Fee S
State Surtax: Fee S S C-1
Total Amount Paid to Village........... Fee S �6)
Signature of Village Official