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City Permit.NO 5390 <br />Contractor Z6) Address 7� <br />Owner �ir'L Address Qdr <br />State License No. Z u a SY City License No. <br />GENERAL PERMIT <br />Cri'Y OF ORONO <br />Crystal Ray, Minnesota <br />473-7357 <br />Parcel No. <br />Section No. Lot Block Subdivision <br />Plat No. <br />Other Description: <br />Date /V -- 'I G - 7 <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 />S'A g­k r— C-,or 1 L7 FF L' -%TT_- X F nib -M -'- / 7-7 <br />Water Meter: <br />Fee 2 <br />Sewer Hookup: (City) <br />Fee S <br />Install Plumbing Systems: <br />Fee $ <br />Install Sewage Disposal Systems: <br />Fee S <br />Install Water Hookup: (City) <br />Fee S _ <br />Install Water Supply Systems: (Well) <br />eo <br />Fee S 1-7— <br />SAC <br />Fee S <br />So <br />State Surtax: <br />Fee $ <br />'d <br />.SU <br />r� <br />Total Amount P to City . .. . . ... <br />. Fee S _--- <br />Siggnnnaatuuurre of applicant <br />Signature (it City O ficwf� <br />Code: White-Fik Copy; Canary -Inspector's Copy; Pink -Finance Copy; Gold -Applicant's Receipt <br />