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City Permit N? 6405 <br />Contractor `SI—ek-41 / 4 J e`�W ? Address AIIAL AW <br />Owner ' / Address <br />State License No, <br />Section No, <br />Parcel No. <br />Plat No. <br />Other Description: <br />City License No. <br />GENERAL PERMIT <br />CITY OF ORONO <br />Crystal Bay, Minnesota / <br />473-7357 Date <br />Lot Block Subdivision <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 City Code of Orono applicable thereto, and shall include all additional specifications as listed <br />below. <br />Water Mater: <br />Fee S <br />Seger Hookup: (City) <br />Fee S <br />[RUA Plumbing Systems: <br />Fee $ <br />Install Sewage Disposal Systems: <br />Fee $ Signature of rpplkant <br />Install Water Hookup: (City) <br />Fee S <br />Install Water Supply Systems: (Well) Fee S �Ll�D <br />SAC Foe S of Ckty wicW <br />State Surtax: Fee $ <br />Total Amount Paid to City .... <br />..... Fee <br />Code: WMte-File Copy; Canary -inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />