HomeMy WebLinkAbout1977-10-14 Permit, Water Well #4982City Permit lv0 4982
Contractor Address I vl TK A Iv► N f
Owner Bt2.r AddressGo. i?-Vseu-i
State License No.
Section No.
Parcel No.
Plat No.
Other Description:
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Date I-q- 77
Lot 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)
Install Water Supply Systems: (Well)
SAC
Fee $
Fee S
Fee S
Fee $ Signature of applicant
Fee $
v•
Fee $_
Fee $
State Surtax: Fee f i SQ
Total Amount Paid to City ......... Fee $ _
Si nature A i y Official
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt