HomeMy WebLinkAbout1979-05-15 Permit, Water Well #5556City Permit N? 5556
Contractor �! �( -Address �iCeC_
Owner_�i�/i r�..�� Address c;;�447—
State License No.
Parcel No.
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357 /
Date ,7
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.
IF V i&Z
Water Meter:
Fee S
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee S
Signature of applicant
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well)
Fee S
SAC
Fee S
Sig • e City Official
State Surtax:
Fee S
Total Amount Paid to City . .. . . ....
Fee $ 1;Y
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt