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Village Permit
Contractor / �� Address �� ..L 4
Owner J Addresses
State License N
Parcel No.
Section No
Plat No
Other Description:
Village License No
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Lot_ Block Subdivision
3'730
Date � — 2 4 � 7,3 --
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 Village Code of Orono applicable thereto, and shall include all additional specifications as listed below.
2 D d2 / _ X
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Water Meter: Fee S
Sewer Hookup: Fee S
Install Plumbing Systems: Fee S
Install Sewage Disposal Systems: Fee S ature of appliCaat -�
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Install Water Hookup: Fee S // I _I tY�
Install Water Supply Systems: Fee S
Install Sewer Hookup:
Fee S
State Surtax: Fee S
Total Amount Paid to Village........... Fee S
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Signature of Village Official
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