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City Permit N? 6363 <br />Contractor L_11 ad; _ . Address SS 3 <br />Owner etA_ Address d 7gt4iv-c¢.�,-o <br />State License No. <br />Parcel No. <br />Section No. Lot <br />Plat No. <br />Other Description: <br />City License No. <br />GENERAL PERMIT <br />(Tl'Y OF OR,ONO <br />Crystal Bay, Minnesota <br />473.7357 <br />Date 7 — /— P / <br />Block Subdivision <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />Water Meter: <br />Fee S <br />Sewer Hookup: (City) <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S Signature a li t <br />Install Water Hookup: (City) <br />Fee $ <br />Install Water Supply Systems: (Well) <br />Fee S <br />SAC <br />Fee S Signature of Cit official <br />State Surtax: <br />Fee $ <br />Total Amount Paid to City ......... <br />Fee S <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Cold-Applik•ant's Receipt <br />