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CiiyhmiltN? 4814 <br />Contractor^ <br />Owner (3^ <br />/yU(^ <br />State Uccnie No.. <br />. Address <br />. Address <br />.City License No. <br />♦1 <br />- /- <br />GENERAL PERMIT <br />ary of orono <br />Crystal Bay, Minnesota <br />473-7357 <br />Parcel No------- <br />Section No--------------------Lot. <br />n-Date. <br />. Block..Subdivision. <br />Plat No. <br />Other Description: <br />m <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, <br />shall comply with the Qty Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />\ <br />WaftrMtttr: <br />Smr Hookup: CCIty) <br />teftoaniMibiivSyilHM: <br />fauia Sawage Disposal System: <br />Instal Water Hookup: (City) <br />InstaB Water Supply Syitcim: (WeU) Fee S <br />SAC Fee $_______ <br />State Surtax: FeeS _____ <br />Feel. <br />1 Fees. <br />Fees. <br />Fees. <br />Fees.f' <br />Signature of Gty OlHcial <br />ToUIAnoiulPddtoaty...................Fwl <br />0)4.; «Ml.Fa. Conr;Cnuiy-Iiii|wctor ‘k Copy:Plak-Fiiiiiic. Copy; Gold-Appllam'i Rwdpt