HomeMy WebLinkAbout1977-08-05 Permit, Water Well #4899City Permit N0 4899
Contractor_ 12y :ems Address
Owner /� �-�i� � Address e�� z(° - -
State License No.
Parcel No.
Section No.
Plat No. _
Other Description:
City License No.
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Date '.�" ..7 7
Lot 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 $
Install Sewage Disposal Systems:
Fee $
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
`
Fee $ll�
SAC
Fee $
Signature of
Signature of City Official
State Surtax: Fee $ S
Total Amount Paid to City ... ... Fee $ a
s
Code: White -File Copy: Canary -Inspector's Copy: Pink -Finance Copy; Gold -Applicant's Receipt