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Contractor e)"u JT' ("Q <br />Owner ij c - <br />State License No. <br />City Pemut N? 5013 <br />Address �6 /�ixz z/e"e <br />Address l A4 5 X47 <br />__City, License No. <br />GENERAL PERMIT <br />CM OF ORONO <br />Crystal Bay, Minnesota <br />473-7357 <br />[)ate S <br />Parcel No. <br />Section No. _ Lot Block <br />Plat No. <br />Other Description: <br />Subdivision <br />hereby agree that, in case a permit is granted, all work which shall he 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 />Water Meter: <br />Fee $ <br />Sewer Hookup: (City) <br />Fee S <br />Install Plumbing Systema: <br />Fee S <br />Install Sewage Disposal Systems: <br />Fee S Signature -,I appik ant v <br />Install Water Hookup: (City) <br />Fee f <br />Go <br />Install water Supply Systems: (well) <br />i ee $ 'I1 <br />SAC <br />Fee S Surest lty Uff��. <br />State Surtax: <br />Fee S 50 <br />Total Amount Paid to City ....... Fee f C20 , <br />Code: wldteF'iie Copy; Caney -Inspector's Copy; PWt-FfuoOw Copy: Gold -Applicant's Receipt <br />