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City Permit Ne 5138 <br />Contractor t rZOA'(, Address2 �� <br />Owner Address a�%/iS <br />State License No. <br />Section No, <br />City License No. <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota <br />473.7357 Date / — 28 — 7A? <br />Parcel No. <br />Lot Block Subdivision <br />Plat No. <br />Other Description: <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 />.� •ter_ r <br />Water Meter: <br />Sewer Hookup: (City) <br />Install Plumbing Systems: <br />Install Sewage Disposal Systems: <br />Install Water Hookup: (City) <br />Install Water Supply Systems: (Well) <br />Fee $ 4b <br />Fee S <br />Fee $ <br />Fee $ <br />Fee S 70 00 <br />Fee f <br />Sig t e offaa plicant <br />SAC Fee f Si;iag <br />ial <br />Sb 11L <br />State Surtax: Fee $ <br />Total Amount Paid to City . .. . ..... Fee $ &O ✓ <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />Water Meter: <br />Sewer Hookup: (City) <br />Install Plumbing Systems: <br />Install Sewage Disposal Systems: <br />Install Water Hookup: (City) <br />Install Water Supply Systems: (Well) <br />Fee $ 4b <br />Fee S <br />Fee $ <br />Fee $ <br />Fee S 70 00 <br />Fee f <br />Sig t e offaa plicant <br />SAC Fee f Si;iag <br />ial <br />Sb 11L <br />State Surtax: Fee $ <br />Total Amount Paid to City . .. . ..... Fee $ &O ✓ <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />