HomeMy WebLinkAbout1978-10-16 Permit, Septic System #5369City Permit N? 5369
Contractor 6 D S H L L► V4.pj Address N A Y hU r
Owner 1j'J • Z' I c M IZ-4AN Address /S6 O FPS' i
State License No.
Section No.
Parcel No.
Plat No.
Other Description:
City License No
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
473.7357 Date Aj_ 16 - 7F1
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 Code of Orono applicable thereto, and shall include all additional specifications as listed
below.
,AClI DCA/titf/ r_>
Water Meter:
Sewer Hookup: (City)
Install Plumbing Systems:
Install Sewage Disposal Systems:
Install Water Hookup: (City)
Install Water Supply Systems: (Well)
SAC
Fee $
Fee $
Fee $
Fee $ 2-0 ture o a lic
Fee $
Fee $
Fee $
s-e
State Surtax: Fee S
Total Amount Paid to City ......... Fee $
Signature of City Official P�
Code: White -File Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold-Appiicant's Receipt