HomeMy WebLinkAbout1978-08-14 Permit, Water Supply System #5278City Permit No 5278
Contractor (1V�K— Address
Owner i % Q.� �p�f/� Address l
State License No.
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Parcel No.
Section No. Lot Block Subdivision
Plat No,
Other Description:
Date— 7J'
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.
Water Meter:
Fee S
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee $
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
oU
Fee $_
SAC
Fee S
Signature of applicant
Signatt 71 City Official
State Surtax: Fee $ S�
Total Amount Paid to City ......... Fee S 17� G G�)
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt