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PERMIT <br />SEWER b WATER <br />CITY OF ORONO PERMIT TYPE: 01102276 <br />1335 Brown Rd South • P.O. Box 66 Permit Number. <br />Crystal Bay, Minnesota 55323 Date Issued: <br />(612) 473-7357 <br />SITE ADDRESS' . <br />DESCRIPTION: <br />Water Permit Type WELL <br />=wer & Water Work: Type RESIDENCE <br />FEE SUMMARY: <br />Baser F ef, S; . C)C) <br />Sub tc.ta1 $ . SO <br />W- k-F ACTO&LL INC B 7 <br />MAPLE PLAIN MN 55359 <br />(611) 479- :1t 1 <br />WELL. <br />T-3t.al Fee $3'o . so <br />447_T31::1 )Qls>'VNER: TOM <br />170CW. 'SADDLEWOC)D TR <br />MINNET13NKA MN 55345 <br />( E-12') I.P"':6-7L ":0 <br />RUMPKI&T 13K SITE; COPY 13F 'STATE: WELL RECORD TO BE SUBMITTED TO THE CITY <br />C)FF l (:EL - <br />THE UNDER, I GNEI) HE RE PY RF OUE ETE: PERM I ' *; J CIN TO MAR: E THE REAL IMPROVEMENTS <br />' PEC I F I Eta AND AGREES TO 013 ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF <br />ORONO l-rRU I NANC:E : AND :t:TA1 E 174- M I NNE-SCITA BU I L-D 1 NG C:c 4)E f�EWt.J 1 RE.ME NTS . <br />4-tP�ICA_N_T/ ERMITE SIGNATURE <br />ISSU BY SIGNATURE <br />J <br />