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City Permit N? 4829 <br />Contractor s� ��/� Address <br />Owner Sf/ Address / �1 <br />State License No. <br />Parcei No. <br />City License No. <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 6_ <br />Date <br />Section No. Lot Block Subdivision <br />Plat No. <br />Other Description: <br />I hereby agree that, in case a permit is granted, all wore 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 />Water Meter: <br />Fee S <br />Sever Hookup: (City) <br />Fee $ <br />Install Plumbing Systems: <br />Fee S <br />Instal Sewage Disposal Systems: <br />Fee $ <br />Install Water Hookup: (City) <br />Fee $ <br />In" Water Supply Systems: (Well) <br />Fee S <br />SAC <br />Fee S <br />State Surtax: <br />Fee S — S� <br />Signature of applicant <br />Signature of City official <br />�ra!:4� <br />TotalAmount Paid to City ......... Fee S CK S <br />Code: WMte-FUe Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />