HomeMy WebLinkAbout1976-01-16 Permit, Water Meter #4323Village Permit N° .- 4323
Contractor Px" C�d— Address
OwneI , AAlAd — Address r R44 7U-♦4'-'
State License No
Parcel No.
Section No
Plat No
Other Description:
Village License N
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Lot Block Subdivision
Date / —14 ` /
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 specifications as listed below.
Water Meter:
Sewer Hookup:
Install Plumbing Systems:
Install Sewage Disposal Systems
Install Water Hookup:
Install Water Supply Systems
Install Sewer Hookup:
A 3$6W7 0 --
15'1/449
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
Fee S
State Surtax: Fee S
Total Amount Paid to Village...... .... Fee S —'k - e)
Signature of applicant
Signature of Village Official