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Village Permit <br />Contractor-6 '� ��ti Address <br />Owner Address Y'a'�- <br />State License No. Village License N <br />Parcel No. <br />Other Description: <br />GENERAL PERMIT <br />VILLAGE <br />Crystal Bay, P "-inesota <br />Date 9 `Z' Y — I c- <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 />Jy v,13 J 3 9 -- <br />�?hC36 <br />Fee Ste_ <br />Install Sewage Disposal Systems: Fee 5 <br />Install Water Hookup: Fee S <br />Install Water Supply Systems: Fee S <br />Install Sewer Hookup: Fee S <br />State Surtax: Fee S <br />Total Amount Paid to Village........... Fee S <br />Signature of applicant <br />Signature of Village Official <br />� I 1 z �L <br />