HomeMy WebLinkAbout1977-10-21 Permit, Sewer Hook Up #49903'v13c. r/ry r,Fs
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City Permit N? _ 4990
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Contractor "Po (K� �4"' Address 7160 (.1.1, //o w Dr b rn 1.
Owners ' (-Z LlCk5C A/ Address T?-o Z0/dr_' t T AJ?ly
State License No.
Parcel No.
City Li :use No.
GENERAL PERMIT
CITY (1F OhONO
Crystal Bay, Minnesota
473-7357 Date l0 Vie ^ 7 7
Section No. Lot Block Subdivision
Plat No.
Other Description:
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)
s^�D
Fee S
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee $
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well) Fee $
Signre of applicant
SAC Fee $ Signat a of City Official
/ 7
State Surtax: Fee $
Total Amount Paid to City ........ Fee $ `% T NI S 7 V,4,4 SFG/Q40 -/QG'%1 /cEE P/%/U f �A
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Code: White -File Copy; Canary -Inspector's Copy;
Pink- nonce Copy; Gold -Applicant's Receipt G ARL l u 1V AJ.41P y /9G S s 04 S'o k
/0-21-77 ,2y1