HomeMy WebLinkAbout1977-09-15 Permit, Water Well #4946Contractor 40,��
Address
City Permit N?
Owner Ate,, Address / tV 6
State License No.
Parcel No.
City License No. _ �a( �15
GENERAL PERMIT
CITY OF ORONO
4946
Crystal Bay, Minnesota
473.7357 C� /� z'z
Date / f
Section No. Lot Block
Plat No.
Other Description:
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 S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee S
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
Fee $_ _
SAC
Fee $
State Surtax:
Fee $
S�
Total Amount Paid to City . ... ....
. Fee $
4tof ant
�1—_V_
Signature of City Official
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt