HomeMy WebLinkAbout1980-08-05 Permit, Water Well #6061City Permit _N? 6061
Contractor �„F.P Address /
Owner Le —A Address 447 � rt, I-C • LA UQt kJC;
State License No. City License No. _
GENERAL PERMIT
CHY OF ORONO
Crystal Bay, Minnesota
473-7357
Date
t
Parcel No.
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
Install Plumbing Systems:
Fee $
Install Sewage Disposal Systems:
Fee $ Signature of applicant
Install Water Hookup: (City)
Fee $
2o.
Install Water Supply Systems: (Well)
Fee S
SAC
Fee S City Offict d
�U 10
State Surtax
Fee S i
Total Amount Paid to City . ... ....
. Fee $ G,
Code: White -File Copy; Canary -Inspector's
Copy: Pink -Finance Cop) : Gold -Applicant's Receipt