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3 <br />OwnaL (c ^ AA-t—- :/t-^ <br />SMc Uccnw N'u- <br />VJbgeP^H; tJSi <br />AddfCst <br />Addieii ^^ <br />VillifC Iktiue K«___________________________ <br />GENERAL PERMIT <br />VILLAGE OF OBOMO <br />OyiM tuf, Minneote <br />y^/?/ y//^ <br />Sectioa No. <br />PtacdNo. <br />Plat No^ <br />Block.Subdivision. <br />Other Deictiptioa: <br />I iMlcby agree that, in case a pennit is giantcd. all uvrk which shall be clone and all inatenah which shall be wed. shall <br />oooipljr with the N'iUage Ccxle of Oroiio applicable thereto, and shall include all additional spccificatkms as hrtaJ bdow. <br />luslall plumbing &>^tcms: Fee $- <br />Imtall. sewage disposal sj’stcms: Fee $-Repair <br />Instill water supply s}stcm$:-------—ri~/ -/---------- 5- <br />^ Fee <br />Total anount paid to ViUagv ............$. <br />Siguatutc of applicant <br />Signature of Village Oftcial