HomeMy WebLinkAbout1976-05-25 Permit, Septic System #4425Village Permit N° 4425
Contractor Address
Owner ✓ ��� r 2' Address- "55 It1 , f r - c i z 166C 7 '.
State License No. _ Village License No "I —
L/C'1
GENERAL
PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Parcel No._
Section No Lot Block Subdivisio
Plat No.
Other Description:
Date —
1 licrcby agree that, in case a permit is granted, all work which shall be done and �!1 materials which shall be used, shall
comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below.
Water Meter:
Fee S
Sewer Hookup:
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee S Signature of a/p licant
Install Water Hookup:
Fee S l
tl
—
Install Water Supply Systems:
Fe: S
Install Sewer Hookup: Fee S
State Surtax: Fee S"
Total Amount Paid to Village .......... Fee S
Signature of Village-O