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City Permit _N? 6302 <br />e <br />Contractor Wt Ate.. Address S'DCC k�r Q <br />Owner , Address 30 R6 <br />State License No. City License No. <br />Parcel No. <br />Section No. Lot <br />Plat No. <br />Other Description: <br />GENERAL PERMIT <br />CITY OF 0110NO <br />Crystal Bay, Minnesota <br />473-7357 / <br />Date�� <br />Block Subdivision <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />Water Meter: Fee S <br />Sewer Hookup: (City) Fee $ <br />Install Plumbing Systems: Fee S <br />Install Sewage Disposal Systems: Fee $ Sig re of a lican / <br />Install Water Hookup: (City) Fee S T_ <br />Install Water Supply Systems: (Well) Fee $ <br />SAC Fee $ Signature f (' Official <br />State Surtax: Fee $ <br />Total Amount Paid to City ......... Fee S , SD <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy: Gold -Applicant's Receipt <br />