HomeMy WebLinkAbout1977-04-26 Permit, Water Well #4789City P
Contractor. `' ly
Z I / / ) �hy�A-1" � J AU Address
Owners1 Ad, ress 3 a 7,!�_ Y -)k 1z I,e. w
State License No. Citv License No.
GENERAL 'ERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357 a 6 _ % 7
Date
Parcel No.
Section No. Lot Block _ Subdivision
Plat No.
Other Description:
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.
I
Water Meter:
Fee S
. Sewer Hookup: (City)
r
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee $
cant
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
Fee S
`?D• n n
SAC
Fee $
Signat e of Of Icial
State Surtax.
Fee S
_
Q i 4 4,v.
i� O
Total Amount Paid to City .........
Fee $
0 b O
Code: White -File Copy; Canary -Inspector's Copy; Pink
-Finance Copy; Gold -Applicant's Receipt