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<br /> � GENERAL P'ERMIT $a��
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<br /> P.O.BOX 66 Date //F� � /�'����� ;^';
<br /> � CRYSTAL BAY,MINNESOT'A SS323 � � d�`;
<br /> � (b 12)473•7337
<br /> ' �""e � Addreu � �;��
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<br /> �. Contractor Addrep �
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<br /> City Licen�e No. �� St�te Licen�e No.
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<br /> REMARKS AND SPECtAL CONDITIONS �F'
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<br /> FEitMIT TYPE AND FEE: I� NEW ❑ADDIT'lON ❑REPAIR ,��'�.`
<br /> � ��; lnside Plumbing(Nfixturos_.) Fer S_..._ Water We11 p�� s���
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<br /> � Water Mtter(Size___) Fce S_.____` Mechanical EquIpment Fe� s_.._,,,._,,.,,,,,,, `
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<br /> _ Fee 5,,.,,...,�.,,,,,,, n��
<br /> � �PVC ❑Cast Q_,__,_ Sprinkkr System(Fin) Fee S
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<br /> � On Site Septic System Fce S °:
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<br /> " ACKNOWLEDGEMENT �`
<br /> � TOTAL ��
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