HomeMy WebLinkAbout1976-11-04 Permit, Septic System #4686City Permit N? . 4686
e
Contractor_ '41' f- >'V Address
Owner Address
State License No.
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Date '7
Block Subdivision
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 $
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee S • �0
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well)
Fee $
SAC
Fee S
State Surtax:
Fee $ • S !�
Total Amount Paid to City .........
Fee S SG7
Signatu u �appi not /
Signature of City Official
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Cold -Applicant's Receipt