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Contractor r' 4T/ .�Gc 1 �c ✓ . <br />Owner <br />Village Permit N° _ 3963 <br />Address <br />Address <br />State License No. Village License No <br />GENERAL PERMIT <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota <br />Date <br />Parcel No. <br />Section No Lot Block Subdivision <br />Plat No <br />Other Description: <br />I hereby agree that, in rase 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 />Water Meter: J— Fee S C- V I() <br />Sewer Hookup: <br />Fee S <br />Install Plumbing Systems: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S <br />Install Water Hookup: <br />Fee S <br />Install Water Supply Systems: <br />Fee $_ <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 />ignature of Village Official <br />A <br />