HomeMy WebLinkAbout1981-03-25 Permit, Water Well #6279City Permit N? 6279
Contractor + OC16L A s w E U-L Address _ � K A
Owner 'e, Co "S*T . AddressFAKVl ew
State License: No.
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License No.
GENERAL PERMIT
GTI�Y OF ORANO
Crystal Bay, Minnesota
473-7357 33-
Date
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:
Sewer Hookup: (City)
Install Plumbing Systems:
Install Sewage Disposal Systems•
Install Water Hookup: (City)
[no" Water Supply Systems: (Well)
Fee S
Fee $
Fee $
Fee $
Fee $
Fee 3 �270,
Signature of apptican-tt�/%� --
SAC Fee $ Signature of 'ty official
l/
State Surtax: Fee S .S0 Q
Total Amount Paid to City ......... Fee $ .LU 5 U
Code: White -File Copy; Canary-lnapector's Copy; Pink -Finance Copy; Cold -Applicant's Receipt