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Village P"t Ng. 897. <br />f <br />Contractor Add fci4l <br />-a <br />f <br />i Own Address/--�-/t <br />It <br />State License No Village Uccnse No- <br />Avg <br />oJ <br />GENERAL PERMIT.6. <br />VILLAGE OF ORONO <br />Crystal Bay, Minnesota' <br />Dat <br />Parcel No <br />Section No.V Plat No No- <br />Lot- Block Subdivision <br />-Other Description: <br />�,/L-'4 <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 />Install plumbing systems: Fee, $ Signature of applicant <br />Install : I <br />sewage disposal systems: Fee Repeft <br />►� { ., . <br />Install Q b <br />iter supply systems:aspic <br />Fcc 51�� <br />Fee $ Signature of Village Official <br />y Total amount paid to Village....... $'—s <br />