HomeMy WebLinkAbout1966-06-16 Permit, Repair Septic System #1159Village Permit N9 1159
Contractor /'� - - --- -Address (
Owner --IX Address
'1. --
State License No.—___ ___ Village License No.—__ ___
Parcel No.
Section No
Plat No
Other Description:
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Irate �` r4
Lot Bloch-- Subdivision—_—_________ _ _- _
I hereby agree that, in case a permit is granted, all work which shall be done and ail materials which shall be used, slull
comply with the Village Code of Orono applicable thereto, and shall include all additional specification; as listed below.
Instill plumbing systems:
Fee—_______
Install
disposal
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sewage systems:
Fee $—
Install
water supply systems:
Repair
Fee $ -
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Fee --
Total amount paid to \ illagc........
Signature of applicant
Siguaturc of Village Official