HomeMy WebLinkAbout1979-06-21 Permit, Sewer Hook Up #5612City Permit N? 5612
Contractor Address
Owner Addresz 7
State License No,
Parcel No.
City License No.
GENERAL PERMIT
CPl'Y OF ORONO
Crystal Bay, Minnesota
473-7357 Date —
Section No. Lot Block Subdivision
Plat No.
Other Description:
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)
Fee S 4p, H7
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee $
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
Fee $
SAC
Fee $
State surtax:
Fee S „ 7r0
Total Amos!;a Paid to City .........
Fee $ a*• -S"O
Signa ure%f a0ficant
Signat f City Official
Code, White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt