HomeMy WebLinkAboutSewer/Water 99-1100
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'Z~LLOW . APPLICAIIT
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~Type of sewer pipe. ABS PVC Cast Iron \~\. ~
,Y' Estimated~ength of sew~~ line ~et.. ..~
~ Clean out (if reqUired)., located f~\J from
( structure. . S
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CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
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APPLICANT:~I J A.1 +(<fZ,UA
ADDRESS: /~ tJ 99 AI dr7'tJ "/(J() c! ~
SIGNATURE: ~~~
SITE ADDRESS: rr /' SAnJC
FILL IN THE BLANKS
1.
Estimated length of water service
/ IC
Size of water service ' inch(es) .
2.
3.
Location of any couplings from structure
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FEES:
$
$
$
35.00
.50
35.50
Sewer and
Surcharge
TOTAL
Fee for either sewer or water
$ .50 surcharge.
* Sewer and water permits issued
recorded on the building permit car
to insure that no duplicate sewer
issued.
*
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DATE PAID
RECEIPT #
REC'O BY
AMOUNT PAID
..
NO. tJtJ-//tO
NOTE:
Sewer and Water
contractors must
be registered
with the City.
PHONE: L/ tf7 - S-71 i
DATE: q., /rY /7~
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BLDG. PERMIT # 98 - 56 /
PID# 25 -/41- 058 - ()
feet.
~A-( fZ:.'
feet.
----1--------
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,
, rmit.
plus
4629 Dakota St. S.E" Prior Lake, Minnesota 55372 / Ph, (612) 447-4230 Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
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