HomeMy WebLinkAbout1969-06-24 Permit, Water Supply System #2166Village Permit N ° 2166
Contractor L— ' e- c'r ( < f Address-,
Owner cI � 1 Q S l F' �f —Address _ ��41��r ✓ c h G �f E ✓✓—
State License No Village License No
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Date
Parcel No
Sxtion No Lot Block Subdivision
Plat No
Other Description:
I hereby agree that, in case a permit is granted, Al work which shall be done and all materials which shall be used, shall
comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below.
Install plumbing systems:
Install
sewage disposal systems
Repair
ll-
nsta
water supply systems:
Repair
Fee $—
Fee-- _
Fee $ �� o
Fee $—_ ---
Total amount paid to Village....... $
Signature of applicant
Signature of Village Official
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