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Village Permit N° 4564 <br />Contractor__.L!-E L`�'tb% L L� vI Address <br />r . f�Ci <br />Owner C�rc' — -- - Address i , to F7 <br />State License No <br />Village License <br />GENERAL PERMIT <br />VILLAGE OF C.-HONO <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 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 />Water Meter: <br />Fee S <br />Sewer Hookup: <br />Fee S <br />Install Plumbing, Systems: <br />Fee S <br />_ <br />Signature of applicant <br />Install Sewage Disposal Systems: <br />Fee S <br />Install Water Hookup: <br />Fee S <br />Install Water Supply Systems: <br />Fee S <br />r <br />A� O <br />Install Sewer Hookup: <br />Fee S <br />Signature of V'llage O,fficia� <br />State Surtax: <br />Fee S <br />5 <br />i{er' 5 <br />; <br />Total Amount Paid to Village........... <br />Fee S <br />