HomeMy WebLinkAboutWater Permit #99-1234
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UEEM - PILE
YELLOW - APPLICANT
GOLD. CIT.,
CITY OF PRIOR LAKE
~r:-,.~l'.- '\.1W.....WATER PERMIT
NO. ''1-/2.3 f
NOTE: Sewer and Water
contractors must
be registered
with the City.
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APPLICANT: 'I.. ri<.;r/V c.ovd-. PHONE: h'r-';).'O':;' I1I(1h,
ADDRESS: y: ~(I Itf~,'t' .s:-/... CcoI\K~ DATE: IQ /,~ Ifq
SIGNATURE: ~~~ J~ BLDG. PERMIT # qq-/z3t:;-
'i"'\ /'/1 0 o..~
SITE ADDRESS: (...01(..1)(' I--";2.L.""'!..f.. '7 \...,..>0. r-L\ r/L.PID#-Z5 -.,-::;>44 - 1')1/- 0
MW"IlJ~T~ @, /54-9'1 FILL IN THE BLANKS
(3 WII-.()~ PALIL~
1 Estimated length of water service
, 2. Size of water service inch(es).
3. Location of any couplings from structure
feet.
(!/'. v 57 DC-
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N)?,--c.-T'-~.J , _ ~_
cpo. L. I.- S ~ t;;.. ...;;:;
feet: L/1..(i-'1'5'Jz...
4. Type of sewer pipe. ABS
PVC
Cast Iron
feet.
5. Estimated length of sewer line
6. Clean out (if req~ired), located at
structure.
feet
from
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This application becomes your permit when approved.
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BY -::;:w /'l-.1e .A~<-/',.t/~ "'/ DATE: /O/IZ '7 '/
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FEES: $ 35.00 Sewer and water line connection permit.
$ .50 Surcharge
.,....-J\ 35.50 TOTAL ,,///~"-~ -. -",
* F,.e~-forl either sewer or water individually is/ $1."I.iiiJ plus ')
tyurCharge. ('---. ~
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of ~ssuance
to insure that no duplicate sewer and water permits are
issued.
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DATE PAID
RECEIPT #
I ..
/(, /12 /C:;'1
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AMOUNT PAID
3{~ -9-/5
REC'D BY
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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