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Clq RmtitNi 5012 <br />Contractor ,[`�~�t�c` ^J as C Address <br />Address ' 1 <br />owner �J – <br />State Liceme No. —Cit) License No. <br />GENERAL PERMIT <br />(QTY OF ORONO <br />Crystal Bay, %Iinnesota <br />473-7357 <br />Date _ <br />Parcel No <br />Section No. Lot Block Subdivision <br />Mat No. <br />Other Description. <br />1 hereby agree that, in cast a permit Is granted, all work which shell he done and all materials which shall he used, <br />shatl comply with the City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />water Meter <br />Fee S _. <br />Sever Hookup 1Ciry 1 <br />Fee f <br />Inatdl Mumbing Sy%I,ms: <br />Fee f <br />Install Severe 1 ,W mal Sy teems <br />Fees fin• 0 <br />Stine ^ ptia <br />Install water Hookup airy i <br />Fee S <br />["stall water Suppl) St ucm+ (Nell) <br />Fee <br />SAC <br />Fee f <br />SI a tel 0t) 0fl 1 <br />\ <br />State Surtax <br />tee f C <br />T <br />Total Amount Paid to City .. Fee f IC -6 C' <br />Code white-F'W Copy. Canary-Ingector'IC opy. Pinkfinance Cupy: Gold-AppUcaai's Rnrlpt <br />