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City Permit N? 5649 <br />Contractor A \ Address S.2 d Ae <br />of <br />Owner C Y At- 13 j 6 / w. address_ KQ .3 c) /. <br />State License No. u� City License No. <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 <br />Parcel No. <br />Section No. Lot Block Subdivision <br />Plat No. <br />Other Description: <br />Date 7 — ;? 5 — 71 <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />�S S <br />Water Meter: Fee S <br />Sewer Hookup: (City) Fee $ !j A <br />lastall Plumbing Systems: Fee t <br />Instal Sewage Disposal Systems: Fee s signature ca <br />Instal Water Hookup: (City) Fee f <br />Install Water Supply Systems: (Well) Fee $ <br />SAC Fee f Signature of City Of cial <br />State Surtax: Fee $ SO <br />Total Amount Paid to City ......... Fees a a <br />Code: White -File Copy; Canary -inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />