HomeMy WebLinkAboutSewer/Water 00-0049
NOTE: Sewer and Water
contractors must
be . registered
with the city.
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SA }"t...e. r P 1 \l M b; ~ c:, .' PHONE: 3'(, - 1/7.31
" v Mill. !iG.1,)
ADDRESS: I'!;'S, 4'f Ill'; i S-\ PI' ~,," L.ok~ DATE: dO S:- f\I f1
F~A.L JLa.. BLDG. PERMJ;T I <f%' - 13J.cJ
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SITE ADDRESS: I \)~1Q Cn""'M.Q"~ Q.. A...JJl. PID#
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APPLICANT:
SIGNATURE:
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GREEN - ....E
YELLOW - APPLICANT
GOLD . C1T1
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
~~
NO.
3.
4.
Location of any couplings from structure
ABS
PVC ../'
$)'
feet.e(() Sed
WI t' " )
fee~"1 )
Cast Iron '=t'f" I '
1.
FILL IN THE BLANKS
Estimated length of water service ~' pe'
I ~:
Size of water service? -, inch(es).
2 .
q..) ,
,-~j
5.
Type of sewer pipe.
feet.
Estimated length of sewer line
6. Clean out (if required), located at
structure.
r.J I)
feet
from
=~=========================~=====================================
This application pecomes your germit when approved.
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BY r~~~. 'Yii%l\..-.. / /--i,/ -:' DATE: (iJ"'Ol~"" ,:,-7, __
!j I f:-' i+t 7/ J..{/" $- I It ~ I qq
===========================~~~;=============~-~-~-============
FEES:
$
$
$
35.00 I( DSewer and water line connection permit.
.50 . '< Surcharge :, ."').'
35. 50 t.j:~';,.., TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction ~ust be
recorded on the building permit card at the time of besuance
to insure that no duplicate sewer and water ~permits are
issued.
DATE PAID /.:? - ,,/
AMOUNT PAID ".;,':-:'
t _,
!.' ()
REC'D BY". " L
{ !
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RECEIPT # ~.' --:'1 ?--:(,
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-
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
III
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