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V411age Permit 3835 <br />Contractor_ ' Address_ <br />t f� <br />OAddress <br />wner <br />State License No <br />Parcel No. <br />Section No <br />Plat No <br />Other Description: <br />Village License No <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Lot _ Bloch Subdivision <br />Date Z,-9. - ,� - 7 3 <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 />coniply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />LziLl-44 <br />,Water Meter: <br />Fee C <br />S <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 />f� <br />Fee S <br />Install Sewer Hookup: <br />Fee S <br />State Surtax: <br />Fee S J L <br />Total Amount Paid to Village....... <br />... Fee S <br />Signature of applicant <br />Signature of Village Official <br />/ c._ ;,cTom'. t � <br />a <br />f( .7 <br />J 1 <br />