HomeMy WebLinkAbout1978-05-18 Permit, Water Well #5161City PermitN? 5161
Contractor .�� o �,A ELL Address 1.S 0 L #LA2 7 _
Owner R�3_CE:1"% Address 3C��,�7 FA,eVl�w
State License No.
City License No.
GENERAL PERMIT
CPI'Y OF ORONO
Crystal Bay, Minnesota
473-7357
Parcel No.
Section No. Lot Block Subdivision
Plat No.
Other Description:
Date _";_ — /e ` 76
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.
TO
Water Meter:
Fee $
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee S Signature of applicant
Install Water Hookup: (City)
Fee S
Install Water Supply System: (Well)
64,
Fee S
SAC
Fee S Signature of City Of cia
Surtax:
Fee $���
ILIState
�`
Total Amount Paid to City .... ....
. Fee $ L—
Code: White -File Copy; Canary -Inspector's Core; Pink -Finance Copy; Gold -Applicant's Receipt