HomeMy WebLinkAbout1978-06-27 Permit, SAC #5221City Permit N! 5221 -
Contractor Address
Owner —hn i) CA [-A S QL Address
State License No. -
Parcel No,
City License No,
GENERAL PERMIT
CUY OF ORONO
Crystal Bay, Minnesota
473-7357 Date G - a Q- -7e
Section No. Lot Block Subdivision
Plat No,
Other Description:
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 S
Install Plumbing Systems:
Fee S
Instil Sewage Disposal Systems:
Fee $ Signat of appli t
In" Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well) Fee S
SAC Fee S �� (�. n Signature of 'ty Official
State Surtax: Fee S
Total Amount Paid to City ......... Fee S -►-�
Code: White -File Copy; Canary-laapector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt