HomeMy WebLinkAbout1973-05-17 Permit, Sewer & Water Hook Up #3644Vine. Pwn* ::' 3644
Conhactor Address
Owner AddressZzkLd
State License No. Village License No
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Date �—/ f% — 7,g-
Parcel No.
Section 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 Village Code of Orono applicable thereto, and shall include all additional speci6ations as listed below.
Water Meter:
Fee S
Sewer Hookup:
Feet �Q•
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Install Water Hookup:
Install Water Supply Systems:
Install Sewer Hookup:
Fee $ Signature of applicant
Fee S
Fee SQ�
Fee S
State Surtax: Fee S '
Total Amount Paid to Village........... Fee S
Signature of Village Official
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