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a v <br />Village Permit N° 4138 <br />Contractor Address <br />Owner �'`-�"^ Address / J � 'K -4 L 6, <br />Statc Licensc No. <br />Parcel No. <br />Section ' ,o <br />Village License No <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Dates <br />Plat No _ <br />Other Description: <br />Lot Block Subdivisio*+ <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall <br />comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />-- lz613971 - <br />57) l?o <br />-� <br />Water Meter: p <br />Fee S �J' tD <br />Sewer Hookup: <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S <br />Install Water Hookup: <br />Fee S <br />Install Water Supply Systems: <br />Fee S <br />Install Sewer Hookup: <br />Fee S <br />State Surtax: <br />Fee S <br />Total Amount Paid to Village.. ........ <br />Fee S <br />Signature of applicant <br />Signature of Village Official <br />rk.�e, <br />W.4 <br />