HomeMy WebLinkAbout1977-06-13 Permit, Water Supply System #4829City Permit N? 4829
Contractor s� ��/� Address
Owner Sf/ Address / �1
State License No.
Parcei No.
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357 6_
Date
Section No. Lot Block Subdivision
Plat No.
Other Description:
I hereby agree that, in case a permit is granted, all wore 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
Sever Hookup: (City)
Fee $
Install Plumbing Systems:
Fee S
Instal Sewage Disposal Systems:
Fee $
Install Water Hookup: (City)
Fee $
In" Water Supply Systems: (Well)
Fee S
SAC
Fee S
State Surtax:
Fee S — S�
Signature of applicant
Signature of City official
�ra!:4�
TotalAmount Paid to City ......... Fee S CK S
Code: WMte-FUe Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt