HomeMy WebLinkAbout1977-10-03 Permit, Septic Repair #4963City Permit No 4963
0001
Contractor eZ _,�,J,. � —e,-Address i aT
Owner Address �V Z
State License No. City License No.
Parcel No,
Section No.
Plat No. _
Other Description:
GENERAL PERMIT
CITY OF ORONO
Crystal Bay, Minnesota
173-7357
Date /6 —3-7 7
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.
Water Meter:
Fee $
Sewer (lookup: (City)
Fee S
Install Plumbing Systems:
Fee S
1'� a, pp�
Instan ewag bisposal Systems:
Fee $ /b .
Install Water Hookup: (City)
Fee $
Install Water Supply Systems: (Well)
Fee S
Signature of appli nt
SAC Fee S Si n of City Oftjr:�f�
State Surtax: Fee
Total Amount Paid to City .. ..... Fee 50
Code: White-FUe Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt