HomeMy WebLinkAbout1978-10-30 Permit, Water Well #5390City Permit.NO 5390
Contractor Z6) Address 7�
Owner �ir'L Address Qdr
State License No. Z u a SY City License No.
GENERAL PERMIT
Cri'Y OF ORONO
Crystal Ray, Minnesota
473-7357
Parcel No.
Section No. Lot Block Subdivision
Plat No.
Other Description:
Date /V -- 'I G - 7
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.
S'A gk r— C-,or 1 L7 FF L' -%TT_- X F nib -M -'- / 7-7
Water Meter:
Fee 2
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee S
Install Water Hookup: (City)
Fee S _
Install Water Supply Systems: (Well)
eo
Fee S 1-7—
SAC
Fee S
So
State Surtax:
Fee $
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.SU
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Total Amount P to City . .. . . ...
. Fee S _---
Siggnnnaatuuurre of applicant
Signature (it City O ficwf�
Code: White-Fik Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt