HomeMy WebLinkAbout1978-01-19 Permit, Water Hook Up #5066City PermitN? 5066
Contractor E=f l¢ Address
Owner Address
State License No. City License No. L� '�—
Parcel No.
Section No.
Plat No. _
Other Description:
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Date
Lot Block Subdivision
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.
Water Meter:
Fee S
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee S Si ure applicant
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well)
Fee $
SAC
Fee $ Signature of City Official -
State Surtax:
Fee $
TOW Amount Paid to City .........
Fee $
Code: Wldte-File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt