HomeMy WebLinkAbout1978-11-29 Permit, Septic System #5428City Permit N? 5428
Contractor CQw& CiT-Y P�—�G Sty Address sy2F', Nicye.Le-r e .
Owner Te,^ AL-R wa Address /0 , r_erwWnAL4'r'_
State License No.
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License No,
GENERAL PERMIT
OF ORONO
Crystal Bay, Minnesota
473-7357 Date // 2p) _-? F3
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:
Fee $
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee $
�e
Install Sewage Disposal Systems:
Fee $ Signat f applicant
Install Water Hookup: (City)
Fee $
Of
Install Water Supply Systems: (Well)
Fee $
SAC
Fee $ Si t re of City Offi ' I
State Surtax:
Fee S
XV
Total Amount Paid to City .........
Fee Sg o
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt