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PERMIT <br />CITY OF ORONO PERMIT TYPE: t.E:WEER t, WATER <br />1335 Brown Rd South • P O Box 66 Permit Number: i)oo:3,39 <br />Crystal Bay, Minnesota 55323 Date Issued: 11 /0 /�:7 <br />(612) 473-7357 <br />SITE ADDRESS: _ <br />4G 1 !t i 1 ij{L:�? l.Ar•.1'- OR <br />DESCRIPTION: <br />":ewer or Wrote- Po:.-rvii t. I yF-E• WE.L.L <br />ewer 8+ Watr�r W.3rk Tyr--e R.' SIDE=Nt <br />f FEE SUMMARY: <br />Ease Vee $ G() WELL --- - - - --$ S?_QQ <br />Surcharge _ ----_1_5!) Tvtal Fee $.30.50 <br />Sub tci, to 1 $ . 50 <br />CONTRACTOR: <br />STOOOLA DON Whl_l. <br />11;::0E. HWY 7 <br />M I NNETONKA <br />( 612 ) yti:c:-1 1 1 1 <br />-- Ap•p 1 i c a►, t. - <br />CID 4' -3:j :1 1 1 <br />MN 5 5:;45 <br />REMARKS: <br />SITE TO BE OK'O BY CITY STAFF <br />SEND C:CIF.Y iIF :TATE WELL RECORD <br />OWNER: <br />_OUG1i1_ I N JOHN <br />4f ] F il1:c :1 l_A14. DR <br />hlD 1N0 MN S5•364 <br />(- THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS <br />SPEC I F I EO ANO AGREES TO 00 ALL WORK IN STRICT COl1Pl__ I ANCE WITH ALL CITY OF <br />L <br />OWW.1 ORDINANCE t: AND t:TATF CIF' M J NNF r:CITA E:U 11.h 1 NCB CODE RF'ok) I REMENTS <br />APPLICANT PERMITEE SIGNATURE ISSUED BY SI ATURE <br />