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City of Gem Lake <br />Heritage Hall <br />4200 Otter Lake Road | Gem Lake, MN 55110 <br />651-747-2790/92 | 651-747-2795 (fax) <br />E-mail city@gemlakemn.org <br />Applicant: <br />Townhouse Accessory StructureTwo-Family HomeSingle-Family HomeCommercialPublic/Institutional <br />ContractorOwner <br />Holding Tank Sale/Transfer of PropertyReplacementNew ConstructionBedroom Addition <br />Reason for Certificate of Compliance <br />Property Information <br />Contractor Information <br />Inspector Information <br />Inspector: <br />Date of Inspection: <br />Phone: <br />Email: <br />Additional Project Details <br />Applicant Signature:Date: <br />Contractor: <br />State License #:Lead Certification #: <br />Phone:Contact Person: <br />Address:Email: <br />Zip:State:City: <br />Property Owner:Phone: <br />Address:Email: <br />Zip:State:City: <br />Approved by:Date: <br />Permit No.: <br />For Office Use Only <br />Septic System Certificate of Compliance