HomeMy WebLinkAboutSewer Water Permit 03-0630
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
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OWNER
PHONE NO.
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TIME
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CONTR.
PERMIT NO.
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o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
~TERHOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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Inspector:
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ON 24 HOURS IN ADVANCE.
Cl!.DE lIEQUI~TS ARE FOR YOUR PERSOl ~HEALTH & SAFETY!
INSNOn /'-
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Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please tvDe or orint and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
I. Green File PERMIT NO 34}
2, Yellow City . D3 -- / '
3, Gold Applicant V
ZONING (office use)
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PIIb.? S -()1 / - /)'-1 I.f -0
OWNER
(Name)
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(Address)
(Address)
APPLICA~ <0.
(Name) tSl":".('~~MaV"\ 1 IVuA-6i~
(Address) ;; 11 ~ ( X to V\ It ,jf~.
(Address)
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(Contact Person) Ch'i:;-r:", 't:x-c-q ;,:..(.C). ~
-. PPLICANT SIGNATURE 17j.~ L.-~
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(City)
(Zip Code)
(Phone) q5} -"I-'S~ ~Oa >t..."
JO~~J'" IAAVI -55~"5'~
(City) (Zip Code)
(Phone) q4) ..y3) . G/.,'3 to
DATE S I CJ :s
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure. \
FEE SCHEDULE (!;U/) ~~
Residential sewer and water line connection $35.50 Industrial, Com'l & MUlti-fami~- {~OfjOb cost with a $39.50 minimum
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Building Permit #
$
$
$
/7- ~--o
.50
L~ - () Q
pa~/9 ,00
Dat~_ d..- 7/0.3
Recetl~555
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