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HomeMy WebLinkAboutSewer & Water Permit 13. 0817 1 li © �{ § j ., 0 \ 0 -1 uu Z g ) )j § ` 1 < \ . �� e - 0 ta � ti ck w o i 0 3 z 6. OOCOOG 0 2 2 : l o _ ° \ § 2 \ \) d ® §_ D a E re §§1� o 0 0 k LI w e o 000< 2 w% c 0 \ 0 § � 2 Z ƒ w c $ § \ q Q a = El = � B ` � a f z ®« ]�� § � � 00 - e c4 0 a■ a■ dI � w ® O ❑oECO §§ � ri ƒ E E / \ >- 0 § - ,.....i_ LU w 0 0 u \ § = Z ^ § R \ .— \ \ W 2 0 z 0 \. ® 0 a r- « 12 § d 2 < / 2 < 3 0 % a. - m 2 ?o? 5�z W w w . g w �j W b $ oo re 2ƒ 1- M . § ƒ w ) 0 ? Q r � 0 0 00� 0 0 0 E U� 0 0 O. 000000 U Roo E ( Ip Date Rec'd CITY OF PRIOR LAKE �, ; '� SEWER AND WATER PERMIT 7 z 5' 13 41/ NNESO C � 1. Green File PERMIT NO . /3 , (s r 2. Yellow City / U 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) /g6 A'r Z -I k-e, - l 4 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) (Address) (City) (Zip Code) (Name �lV ...2l � Cc - vt C.. (Phone) '1 ` f// 7 t ,' S 5 (Address) - 7 7 '7 S J , S F PI- JV4. 4 /14 7 * Address) (Zip Code) (Contact Person) , L 1.‘ &A s - (Phone) Q..) i ', -73' 3 APPLICANT SIGNATURE =� DATE 7 — _ 1_ 3 APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. ❑ ABC ❑ PVC ❑ Cast Iron Estimated length of sewer line feet. 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 AND WATER PERMIT FEE $ mss, CZ STATE SURCHARGE $ .S TOTAL PERMIT FEE $ 3 O 5 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid — , Rec i N o. g5 - 3 v ! Buildine Official Date D ( l 3/ f B (( I �J v 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372