HomeMy WebLinkAbout1978-10-30 Permit, Water Well #5389City Permit-Na 5389
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Owner 4-6—`]2AL_D Address ����9c,
State. License No. �Q � � S City License No.
Parcel No.
Section No.
Plat No. _
Other Description:
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Date /o -30-78
Lot Block Subdivision
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 Cod- of Orono applicable thereto, and shall include all additional specifications as listed
below.
SU'st- I -r- l.-V/y &F c L" ts1-c- rer"T__, _iy C 11 1�
Water Meter:
Fee S
Sewer Hookup: (City)
Fee $
Install Plumbing Systems:
Fee S
Install Sewage Disposal Systems:
Fee S
Install Water Hookup: (City)
Fee S
Install Water Supply Systems: (Well)
H
Fee $
Signature of applicpnt
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SAC Fee $ Si t rC,of tt fici•
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State Surtax: Fee $ �
S
Total Amount 1• tid to City . ... ..... Fee S _
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt