HomeMy WebLinkAbout1977-06-29 Permit, Septic & Plumbing #4852City Permit N? 4852
Contractor Address
Owner K I/A j G fps Address ) B 7 Al/
State License No.
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License No
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota AA q
473.7357 Date
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 S
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee $ .�(o
Install Sewage Disposal Systems:
Fee $
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well) Fee $
Signature of applicant
,c..l
SAC Fee S Signature of City Official
I�
State Surtax: Fee S
Total Amount Paid to City .... .... . Fee $ AD
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt