HomeMy WebLinkAbout1977-10-06 Permit, New Water Well #4966City Permit 1`j 9 4966
Contractor �Address
Owner �k:GICs^✓ Address
State License No
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License No,
GENERAL PERMIT
CITY OF ORONO
Crystal Day, Minnesota
473-7357
Date
Block Subdivision
1194-77
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 $
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee $
Sign:,ture �If applicant
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well)
Fee S
SAC
Fee $
Si re of City Offic
State Surtax:
Fee S
Total Amount Paid to City ......... Fee S 120. SO
Code: White-Flle Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt