HomeMy WebLinkAbout1976-11-26 Permit, Water Supply System #4712City Permit N? 4712
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Contractor � �/� Address /�D
Owner 4� Address %`/5O9 xa-e
State License No. City License No. _
GENERAL PERMIT
CITY OF ORONO
Parcel No.
Section No. Lot
Plat No.
Other Description:
Crystal Bay, Minnesota
473-7357
Block Subdivision
Date
6 — 74
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 $
i
Install Sewage Disposal Systems: Fee $ ___S+ttwatm�T applicant,
Install Water Hookup: (City) Fee S
Install Water Supply Systems: (Well) Fee $ 119.00
SAC Fee S Signature o Cit •• Of
State Surtax: Fee $ So
Total Amount Paid to City ......... Fee S do , S O /
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt