HomeMy WebLinkAbout1978-03-28 Permit, Water Well #5114City Pennit No 5114
ContractorAddress /
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Owner R.iCh-11�� �S n-t.•N Address LO-1 - S► j FA'2W/ELe7
State License No.
Parcel No.
Section No.
Plat No. _
Other Description:
City License No.
GE-?ERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357 Date 3 2 7
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 $
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee S
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
Fee S7
Signature 'itsol4
ant
rk
SAC Fee $ Signature of City Offil
State Surtax: Fee S --
Total Amount Paid to City .... ..... Fee S
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt