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City Permit N? 6124 <br />Contractor _ Address — <br />Owner- �� '- _ Address > `� ���� �—k' —� <br />State License No <br />Parcel No, <br />Section No. <br />Plat No. _ <br />Other Description: <br />City License No. <br />GENERAL PEF MIT <br />CITY OF ORONO <br />Crystal Bay, MinnesWa <br />473-7357 <br />Dote <br />Lot Block Subdivision <br />I hereby agree that, in case a permit is granted, all work which shall be dote and all materials which shall be used, <br />shall comply with the City Code of Orono applicable tl.ereto, and shall include all additional specifications as listed <br />below. <br />•.1 .mil / � <br />Water Meter: <br />Fee $ _ <br />Sewer Hookup: (City) <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />I-ce $ <br />Install Water Hookup: (City) <br />Fee $ <br />W S 1 S t (Well) <br />Fee S <br />�aature u( applica <br />Cc`_ ._ <br />Install ater upp y ys ems. <br />Fee $ Signature of City Uffiria <br />SAC <br />State Surtax: Fee S <br />Total Amount Paid to City . ... .... Fee $_ <br />Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />