HomeMy WebLinkAbout1977-06-30 Permit, City Water Hookup #4854CityPermitN? _ 4854
Contractor 5"J/t e-- _ Address
Owner tlyt__1'�11 M Z A1 Address f lya&e_ M&_�/1/
State License No.
Section No.
Parcel No,
Plat No.
Other Description:
City License No.
GENERAL PERMIT
CITY OF OR,ONO
Crystal Bay, Minnesota
473-7357
Lot Block Subdivision
Date
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 a- -d
below.
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Water Meter:
Fee $
O JI 0 0
X
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee $
Signature of app
Install Water Hookup: (City)
Fee S
'
Install Water Supply Systems: (Wen)
Fee S
SAC
Fee S
Signature oc city official
State Surtax:
Fee $
• J�O
G,IC�/+aA��,
Total Amount Paid to City .........
Fee $ 100 , SD
Code: WNte-File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Cold -Applicant's Receipt