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City Permit N? 4852 <br />Contractor Address <br />Owner K I/A j G fps Address ) B 7 Al/ <br />State License No. <br />Parcel No. <br />Section No. Lot <br />Plat No. <br />Other Description: <br />City License No <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota AA q <br />473.7357 Date <br />Block Subdivision <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />Water Meter: <br />Fee S <br />Sewer Hookup: (City) <br />Fee S <br />Install Plumbing Systems: <br />Fee $ .�(o <br />Install Sewage Disposal Systems: <br />Fee $ <br />Install Water Hookup: (City) <br />Fee $ <br />Install Water Supply Systems: (Well) Fee $ <br />Signature of applicant <br />,c..l <br />SAC Fee S Signature of City Official <br />I� <br />State Surtax: Fee S <br />Total Amount Paid to City .... .... . Fee $ AD <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />