HomeMy WebLinkAbout1977-03-14 Permit, Water Well #4763City PermitN? 4763
Contractor ) Address
Owner � / Address 6-
State License No. `
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License N-
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Block Subdivision
Date
3-/�Z-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 S
Sewer Hookup: (City)
[:cc S —
Install Plumbing Systems:
Fee S
Install Sewage Disposal systems:
Fee S Signature of applicant
Install Water Hookup: (City)
I ee S
Install Water Supply Systems: (Well)
Fee S
SAC Fee $ r Sit:na rr t (' ty Offic'
State Surtax: Fee $ 1 SO
Total Amount Paid to City . . . ..... Fee $ /' o.s0
Code: White -File Copy, Canary -Inspector's Copy; Pink -Finance Copy; Gold-AppUcant's Receipt