HomeMy WebLinkAboutSewer/Water 99-0349
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GREEN . FILE
YELLOW . APPLICANT
GOLD. CITY
CITY OF PRIOR LAKE NO aCf... ~ :3 4D
SEWER AND WATER PERMIT . (; I ~
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT: _~ A \ ..v,,-t\ tbv\S~\.AL,\:lO'V\
IS~ L:b;;"'" S~ W
SIGNATURE: q,--,- __7
SITE ADDRESS: l~~CXJ 1)~t\~~ ~
ADDRESS:
PHONE: ~ \'L 7SCV ~2..\ctb
DA TE : 4\ l <<:\- \ '\ '1
BLDG. PERMIT # Cj Uj, 1ft
PID# .2.5-111-60Y.- I
FILL IN THE BLANKS
1. Estimated length of water service f\)J\
feet.
2. Size of water service
NA
inch(es) .
3. Location of any couplings from structure feet.
4. Type of sewer pipe. ABS PVC~ Cast Iron
'_+ a..O
5. Estimated length of sewer line v feet.
6. Clean out
required), located at
feet
from
BY
permit when apprO~d.~
DATE: 4-. 4- r
l (
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
*
Fee for either sewer or water
$ .50 surcharge.
individually
is
-S:;~.~.. 0)
.."--.."..,....
plus
*
Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issqance
to insure that ~o duplicate sewer and water permits are
issued. 4-! tt.- ~ ~
DATE PAID {l, ('c. L
RECEIPT # 350/7
AMOUNT PAID
20, sO
P-/) /+~
REC/D BY
16200 Eagle Creek Av. S.B., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230/ FAX (612) 447-4
An Equal Opportunity Employer
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