HomeMy WebLinkAbout1977-07-22 Permit, Water Well #4881City Permit-f 0 4881
Contractor Address _
Owner 9A44_z ' AddressR—
State License No.
Parcel No.
Section No. Lot
Plat No.
Other Description:
City Licensc No
GENERAL PERMIT
CITY OF OR,ONO
Crystai Bay, Minnesota
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:
I ee S
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee S Signature of applicant
Install Water Hookup: (City)
Pee S --
Install Water Supply Systems: (Well)
Fee $
SAC Fee S Signature of Cit IOfFi
State Surtax: Fee t L
Total Amount Paid to City .... .... . Pee $ S�
Code: Wldte-File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt
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