HomeMy WebLinkAbout1976-04-29 Permit, Sewer Hook Up #4386Village Permit ?�Tu 4 3 8 6
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Contractor " '- -f- _ Address
Owner ���, "t Address —
State License No._ Village License No--- -?
GENERAL PERMIT
VILLAGE OF ORONO
Crystal Bay, Minnesota
Date
l - i-
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Parcel No.
Section No Lot Block Subdivision
Plat No. ---
Other Description:
1 hereby agree that, in case a permit is granted, 211 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 ail additional specifications as listed below.
Water Meter:
Sewer Hookup:
Fee S
Fee S _t' el0
Install Plumbing Systems:
Fee S _
Install Sewage Disposal Systems.
Fee S
Install Water Hookup-
Fc e S
Install Water Supply Systems:
Fee S
Install Sewer Hookup:
Fee S
State Surtax:
Fee S SC
Total Amount Paid to Village....... . . Fee S <'e" S C
Signature o%f applicant
Signature of Village Offr ial