HomeMy WebLinkAboutSewer/Water Permit 11-300 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED zi 5 I
ADDRESS zi c?5LJ eNkr
OWNER CONTR.
PHONE NO. PERMIT NO. 1(— 0
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD /FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION fie-SEWER HOOKUP � cuj - E1 FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GASLINE AIR TST
❑ SITE INSPECTION ❑ MECH FINAL ❑
COMMENTS:
1 1
2
C t C,5d_ 41 - 1 -
❑ WORK SATISFACTORY, PROCEED
CORRECT • TION AND PROCEED
❑ CORREC ' ►" , CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner /Contr:
CALL. • 7 -9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
c 1 - ) -- R .5)
O R Date Rec'd
, rt ? CITY OF PRIOR LAKE
V ;� r� SEWER AND WATER PERMIT
jNNESO
1. Green File PERMIT NO //77 /�
2. Gol A I iry / L ®/
3. Gold Applicant J (�
(Please type or print and sign at bottom) r
_ ADDRESS ZONING (office use)
" 0 C� b i i 4 veil- /cJ ,3
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER _ —
7- (Name) / OM. / K 1e-et i e (Phone)
(Address) 4 ( e-i i % � t lK./L _ 1 Q Pt- 3 7 7)—
(Address) (City) (Zip Code)
APPLICANT
(Name) / Il J/e S JP 77 " (Phone) '14‘110
/60 7 (e / 2t A �6 1 _55 3
(Address) Gt W p
y�,� (Address) / (City) (Zip Code)
//
(Contact Person) l r / ' OL A il 7! it ,. till- (Phone) 4 0 ' er•D
APPLICANT SIGNATURE ` G A__ _ _ ■ ' - — DATE -4 li /
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet. II
Type of sewer pipe. ABC , 1. ' VC I Cast Iron
Estimated length of sewer ine 20 eet.
Clean out (if required) located at feet from structure.
FEE SCHEDULE
Residential sewer and water line connection $51.50 Industrial, Com'l & Multi - family 1% of job cost with a $51.50 minimum
Sewer connection only $25.50 Water connection only $25.50
Estimated Cost $ Building Permit #
SEWER AI PERMIT FEE $ 2- 5c- -0
STATE SURCHARGE $ .500
TOTAL PERMIT FEE $ 3 01 SO
(Office Use Only)
This Ap , ti n Becomes Yhr Building Permit hen • pproved Paid r-40 Receipt No.
g /1r_ 4- ' ( Date By gp W dine'I fficial Date 7- 7 f.-
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372