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Section No
004r Description;
Village Permit
_- 7 JAddres
Ad
it ')Ucense No
GE lvj L P M
VI A�E, OF ORO,I�
Crystal it Miffnesota
1
Date
Parcel
!, Lot $lode Subdivision
Plat No
I hereby agree that, irk case a per
comply with the Village C gde'of,
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t
n# is granted, all work which skAIr be- dome and all materials which shall be used, shall
ionb ^apod2ble thereto, aJ shall include —all additional specifications as listed below.
rL eJ1. — Op / �T� c� J
CA- . o
11
Install plumbing systems: Fee $ Signature of applicant
i
Install -�
sewage disposal systems: Fee $ ;r
Repair
Install
water supply systems: Fee $ZG
Repair �� Signature of Village Official '*
Fee $
Total amount paid to Villag��G.1$�� '