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Yllage FMM0 <br /> Addr <br /> Contractor Addr <br /> ::1 <br /> owner <br /> J� <br /> Vil"rage License No <br /> State LicenseGENBAANo <br /> L PERMIT <br /> ' at-�A GE OF ORONO <br /> V, I L. <br /> Crystal Bay, Minnesota te-J � <br /> Da <br /> Parcel ----- <br /> LO <br /> Subdivision- <br /> $ection No--- <br /> Plat No. ._------ <br /> `on: <br /> Other D�nPt' ` <br /> . i one and all materials which shall be ns�d' Sb <br /> granted, all work Ivbich shall bed cations is listed belo* ' <br /> that • it is gra <br /> �Ll►ereby,agrce 'n mse a i hcab]e tberct>>,and shall include all additional <br /> A Code of Orono app• r `� r <br /> ra p1Y wAh the Village <br /> i <br /> S <br /> Signature o[ applicant <br /> k Fee ------ <br /> � ` Install plumbing systems: , <br /> InstallFee S----' <br /> stege disposal systems: <br /> Repair <br /> Install systems* Fee -------- Signature of Village <br /> water sup ly Ys <br /> Repair Fee T1s'- "Y1 L <br /> Total a ot�-c l� t Village....... $— "-- <br /> tiU.N. <br />