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Contractor _ Address <br />Owner. Tt Address -- <br />State License No. Village Licepse No <br />Parcel No. <br />Section No — <br />Plat No <br />Other Description: <br />'pillage Permit N° 4 4 61 <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Lot Block Subdivision <br />Date l • .2 /- 7G <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall <br />comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />S�fl N <br />Water Meter: <br />Sewer Hookup: <br />Install Plumbing Systems: <br />Install Sewage Disposal Systems <br />Install Water Hookup: <br />Install Water Supply Systems: <br />Install Sewer Hookup: <br />State Surtax: <br />Fee $ 0' OO <br />Fee S <br />Fee S <br />Fee i LS'u:re' f pplicanFee S <br />Fee S <br />Fee S <br />Fee S <br />Total Amount Paid to Village........... Fee S e - -<e <br />Signature of Village Official <br />J <br />