HomeMy WebLinkAbout1979-05-21 Permit, Water Well #5563City Permit No _ 5563
Contractor Qoy/yEl_ 4- SoNS' Address 6 -Scyn IA/Dcta'tr_-/ A6ms-Ao%,b'1z,I
Owner 2i4 V 1 z> /U r T 2L Address 3 0Se% F�t-✓ /
State License No. _...� City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Parcel No.
Section No. Lot Block Subdivision
Plat No.
Other Description:
Date "Z / — 717
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.
5EAMMUNW-Z P1110
Water Meter:
Fee $
Sewer Hookup: (City)
Fee 5
Install Plumbing Systems:
Fee S
Instal Sewage Disposal Systems:
Fee S
Install Water Hookup: (City)
Fee S
�o
Install Water Supply Systems: (Well)
Fee S
SAC Fee S Si"ure ofWy OLficial
State Surtax: Fee S
Total Amount Paid to City ......... Fee $
Code: W1dte-File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt