HomeMy WebLinkAbout1976-4730 - general permit c.
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Contractor Address
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Owner Address O�''
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State License No. ��� �� City License No.
GENERAL PERMIT
C�ITY OF ORONO
Crystal Bay, Minnesota
473-7357 /� � ��� �
Date�
Parcel No.
Section No. Lot Block Subdivision
Plat No.
Other Description:
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.
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Water Meter: Fee$ ��• � �
Sewer Hookup: (City) Fee$
Install Plumbing Systems: Fee$ --- ^
Install Sewage Disposal Systems: Fee$ Signature of a lica �`� /'9!(��—�
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Install Water Hookup: (City) Fee$
Install Water Supply Systems: (Well) Fee$
SAC Fee$ Signature C' O i 'al
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State Surtax: Fee$
Total Amount Paid to City . . . . . . . . . Fee$ �a�C�
Code:White-File Copy;Canary-Inspector's Copy;Pink-Finance Copy;Gold-Applicant's Receipt