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Jv <br />Village Permit N° 4383 <br />Contractor Addres <br />Owner l/l��fL'et rfZ�/l`_ Address — <br />State License No. _ Village License No. <br />Parcel No. <br />Section No <br />Plat No <br />Other Description: <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Lot Block Subdivision <br />Date <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall <br />comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />C-�t�C 7e' elO <br />Fes? <br />Water Meter: <br />Fee S <br />Sewer Hookup: <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S <br />Install Water Hookup: <br />Fee S <br />Install Water Supply Systems: <br />Fee S <br />Install Sewer Hookup: <br />Fee S <br />State Surtax <br />Fee S <br />Total Amount Paid to Villagc <br />L <br />Fee S <br />Signature of applicant <br />i <br />Signature of Village Official <br />