HomeMy WebLinkAbout1975-11-17 Permit, Septic & Plumbing #4273Village Permit N° 4273
Contractor 4�y Addressr `
Owners Addressc
State License No
Section No
Other Description:
Village License No
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Date
Parcel No.
Lot Block Subdivision
Plat No
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 Village Code of Orono applicable thereto, and shall include all additional specifications as listed below.
Water Meter: Fee S
Sewer Hookup: Fee S
Install Plumbing Systems: /6 Fee S J .
Install Sewage Disposal Systems: Fee S � tC C
Install Water Hookup: Fee S
Install Water Supply Systems: Fee S
Install Sewer Hookup: Fee S hh
State Surtax: Fee S . JO
Total Amount Paid to Village........... Fee S
5z • p
Signature of applicant
Signature of Village Official