HomeMy WebLinkAbout1978-04-28 Permit, Water Hook Up & Meter #5138City Permit Ne 5138
Contractor t rZOA'(, Address2 ��
Owner Address a�%/iS
State License No.
Section No,
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473.7357 Date / — 28 — 7A?
Parcel No.
Lot Block Subdivision
Plat No.
Other Description:
I hereby agree that, in case a permit is granted, all work 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.
.� •ter_ r
Water Meter:
Sewer Hookup: (City)
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup: (City)
Install Water Supply Systems: (Well)
Fee $ 4b
Fee S
Fee $
Fee $
Fee S 70 00
Fee f
Sig t e offaa plicant
SAC Fee f Si;iag
ial
Sb 11L
State Surtax: Fee $
Total Amount Paid to City . .. . ..... Fee $ &O ✓
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt
Water Meter:
Sewer Hookup: (City)
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup: (City)
Install Water Supply Systems: (Well)
Fee $ 4b
Fee S
Fee $
Fee $
Fee S 70 00
Fee f
Sig t e offaa plicant
SAC Fee f Si;iag
ial
Sb 11L
State Surtax: Fee $
Total Amount Paid to City . .. . ..... Fee $ &O ✓
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt