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GENERAL PERMIT <br />CITY PERMIT NO. 6892 1 <br />CITY OF OR( NO Date 1f�- -�� <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357j7 1,, <br />Ownerki/ Address O ' � Sk <br />Contractor / 3r Address 656 (-�l//S — 96,64d— <br />City License No <br />REMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: NEW ❑ ADDITION <br />Inside Plumbing ( # fixtures ) Fee $ <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />Fee $ <br />Municipal Water Connection Fee $c <br />❑ Copper 0 <br />Municipal Sewer Connection Fee $ _6 <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ Pfi tU <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special information, <br />terms, conditions or requirements written above. The <br />undersigned understands and agrees under penalty of law <br />that this permit is strictly limited in scope to the work, <br />activity or improvement specified; that this permit does <br />not grant any authority to do work or activities requiring <br />separate permit approvals; and that this permit does not <br />grant authority to violate any provision of any City <br />ordinance or State law, rule or regulation. All work &hall be <br />done in strict compliance with all City ordinances, building <br />codes and/or health department regulations, and shall be <br />subject to inspection, approval or rejection by the City. <br />Whenever so ordered, the undersigned agrees to correct <br />any work found to be in vioiation of the conditions of <br />this _ rmit. <br />re of Applicant <br />State License No. <br />❑ REPAIR <br />On Site Septic System <br />Water Well <br />Mechanical Equipment <br />Moving/Lifting Buildings <br />Land Alteration (Excavation, <br />Grading, Filling, etc.) <br />Other: <br />After -the -fact Investigation <br />TOTAL <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />Fee <br />$ <br />State Surcharge: Fee $ <br />Total Amount Paid to City Fee $--A. 00 <br />This permit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Sig t e of City Official <br />11-4 <br />®�s <br />Code: White —Pile Copy Canary —Inspector's Copy Pink -Finance Copy Gold Applicant's Receipt <br />