HomeMy WebLinkAboutSewer & Water 99-0821
SEE INSPECTION
RECOmSUNU3~
BUIL~ING PERMIT
#99-0836
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GREEN - F1LE
YELLOW - APPliCANT
GOLD. elT\'
CITY OF PRIOR LAKE NO. .2::/ ~ ;) Z I
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the city.
APPLICANT: >1(v-l j/f';>P:7 DliI1;;'(fSb.7PHONE: C/"J'~ - 5760
ADDRESS: ~)?fY.J /~/.~ 1}2~1" / DATE: 7- J- 9'Q
SIGNATURE: ~_-F)1t~;!/{7:f BLDG. PERMIT #
SITE ADDRESS: it-51/ IJ""~/-//fn.if Sf.
PID#
7-
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'10 Z .. ,_... '7/1. C.I
FILL IN THE BLANKS
1. Estimated length of water service
90
feet.
2 .
3 .
//'/
Size of water service ~
inch(es). ./
Ql.,,:r~/-.
f~rnstructure ;? ()
feet.
Location of any couplings
4. Type of sewer pipe. ABS
PVC
Cast Iron
Dr? Y
5. Estimated length of sewer line' LS-
feet.
6. Clean out (if required), located at - 0- feet
structure.
from
BY
application
.-<
)(.< I'
-t -'
, " J.../. :,
DATE:
approved.
< j
i//) .j
< j
r l': .J.;,c:f ~~W '
becomes your p~tmit when
This
~
------
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, i/.Oo
I(c FEES: $
$
$
-1'" .j'~
3!> nn
.50
.~.50
1;''50
Fee for either sewer or
$ .50 surcharge.
Sewer and
Surcharge
TOTAL
water line connection permit.
*
water
individually is $~1.00 plus
*
Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
.~ /, 10. -
'.' ./
AMOUNT PAID
RECEIPT #
>~..:;- S. (jr)
REC'D BY
If. ~u
(- nq
DATE PAID
4629 Dakota SI. SE, Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPlDYER
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