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GENERAL PERMIT <br />CITY OF v.►? ONO <br />P.O.BOX 66 <br />CRYSTAL BAY, MINNESOTA 55323 <br />(612) 473-7357 <br />CITY PERMIT NO. 70211 <br />Date 4 ff - (f- 3 <br />Owner Address t- 6 n <br />Contractor ', ­Ll e4go JsC_ Address _ (-Q6() <br />City License No. /q &3 lj.,,eL State License No. <br />RLMARKS AND SPECIAL CONDITIONS <br />PERMIT TYPE AND FEE: <br />Inside Plumbing ( # fixtures <br />Water Meter (Size ) <br />Meter # <br />Remote # <br />(NEW ❑ ADDITION <br />_) Fee $ <br />Fee $ <br />Municipal Water Connection Fee $ <br />❑ Copper n <br />Municipal Sewer Connection Fee $ <br />❑ PVC ❑ Cast n <br />MWCC SAC Charge <br />ACKNOWLEDGEMENT <br />Fee $ <br />The undersigned hereby acknowledges receipt of this limited <br />permit, including acceptance of all special Information, <br />terms,-unaiNons 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 shall 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 violation of the conditions of <br />this permit. <br />S1 ture of Ap icant <br />FA <br />❑ REPAIR <br />On Site Septic System Fee S 3 le G,O <br />Water Well Fee S <br />Mechanical Equipment Fee $ <br />Moving/Lifting Buildings Fee $ <br />Land Alteration (Excavation, Fee $ <br />Grading, Filling, etc.) <br />Other: Fee S <br />After -the -fact Investigation Fee $ <br />TOTAL <br />State Surcharge: <br />Total Amount Paid to City <br />Fee S So <br />Fee S 3S. -CO <br />This pennit is not valid until the proper fee is paid and <br />it is approved by an authorized City Official. <br />Signature of City Official <br />Code: White -- tile Copy Canary Inspector's Copy Pink I inance Copy Gold Applicant's Receipt <br />