HomeMy WebLinkAbout1979-03-06 Permit, Water Well #5501City Permit Na 5501
Contractor L E c, TH /VEIL We L 4 6 . AddrPgs 1 C40r ►a
Owner ��, . aiZMinLA CAR LSot4 Address � 5/-orZtST- Aztj Lt,.
State License No.
Section No.
Parcel No.
Plat No.
Other Description:
City License No.
GENERAL PERMIT
GTl'Y OF OftONO
Crystal Bay, Minnesota
473-7357 3.- 79
Date
Lot Block Subdivision
I hereby agree that, in case a permit is granted, all work which shall be done and ail 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 S
Install Plumbing Systems:
Fee $ _
Install Sewage Disposal Systems:
Fee S Signat applicant
Install Water Hookup: (City)
Fee S'�
Install Water Supply Systems: (Well)
Fee S
SAC
Fee S Signat a of City O c"
State Surtax:
Fee $ , 5�
Total Amount Paid to City .........
�d
Fee $
Code: WNte•File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt