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Contractor—/J Address <br />Owner laC 4 410E C -A 44-42 <br />Address—// <br />State License No. Village License No <br />Parcel No. <br />Section No <br />Plat No <br />Other Description: <br />Village Permit N4 4 2 2 4 <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Lot Block Subdivision <br />Date Ib - %% — 7 S7_ <br />I hereby agree that, in case a permit is granted, all work which shall be done and all materials which shall be used, shall <br />comply with the Village Code of Orono applicable thereto, and shall include all additional specifications as listed below. <br />0 -it Lr3�.S.�a <br />Water Meter: <br />Fee S <br />Sewer Hookup: <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage IS - : .I ^;j stems: <br />Fee S <br />Install Water Hookup: <br />Fcr S <br />Install Water Supply Systems: <br />I ee S_ <br />Install Sewer Hookup: <br />Fee S <br />State Surtax: <br />Fee S <br />Total Amount Paid to Village ......... <br />Fee S <br />Signature of applicant <br />Signature of Village Official <br />1 t , IIQ GC 1-� <br />