HomeMy WebLinkAboutS/W PERMIT 94-0097 �
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CITY OF PRIOR LAKE NO . C�' � (
�J�'NES��P SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT: f�,Ql�a� �/�/YP / PHONE: LI�I� f��,6
ADDRESS : L�.� ��p G� ��� r�� S�� DATE :�-,p7J� ��
S IGNATURE : �,¢� t,Oc,,.._, BLDG . PERMIT # E1 �`-1 -0 Z-- '
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SITE ADDRESS: l(L1Ur�� s9`- �U� ,�U� S-� PID# �
FILL IN THE BLANKS
1. Estimated length of water service � feet.
2. Size of water service inch(es).
3. Location of any couplings from structure feet.
4. Type of sewer pipe. ABS PVC� Cast Iron
5. Estimated length of sewer line � C� feet.
�_!�
6. Clean out (if reqt��M ' -- =feet from
structure.
CLOSED DUE TO
________________________= INACTIVITY 8/30/O1 =______________
This a becomes � Q /
BY DATE : C�` � � �
FEES: $ 35.00 Sewer and water line connection permit.
$ .50 Surcharge
$ 35.50 TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* 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.
DATE PAI D Z r AMOUNT PAI D ��
RECEIPT # � �� � REC'D BY �
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPUJYER �