HomeMy WebLinkAbout1978-11-06 Permit, Water Well #5402City Permit.TO 5402
Contractor ST-OD O L A tA 1 Et-L Address z c),: f 1wY / k-\7*4
Owner AN ,—,W 6-bcsrr' Address / 3 s- F�X Sz-.
State License No,
Parcel No.
Section No. Lot
Plat No.
Other Description:
City License No,
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473-7357
Date
Block Subdivision
I hereby agree that, in case a permit is granted, all work which shall be done and all materials which :iall be used,
shall comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
1./D A p—/ LC (�Eb W�zM 1�
Water Meter:
Fee $
Sewer Hookup: (City)
Fee S
Install Plumbing Systems:
Fee $
Install Sewage Disposal S;-stems:
Fee $
_
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
Fee S
Fee S
CIO
State Surtax:
Fee $
' 41)
Signature of applicant
Signature of City ffici
Total Amount Paid to City .. ..... . Fee S1�
Code: White -File Copy; Canary inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt