HomeMy WebLinkAbout1981-03-11 Permit, Water Well #6269City Permit N? 6269
Contractor sy: t!r GZ - ZC1�7 Address
Owner Lc t _ Address
State License No.
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License No.
GENEKAL PERMIT
CITY OF MONO
Crystal Bay, Minnesota
473-7357
Date dd
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 $ _
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Install Water Hookup: (City)
Fee S
Fee S
Signature of applicant
Install Water Supply Systems: (Well)
Fee S
SAC Fee S Signature of Cit Ic j
State Surtax: Fee $ 5 C, % -------
I s- L
Total Amount Paid to City . .. . . .... Fee S +"��
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt