HomeMy WebLinkAboutSewer Line 10.747 & 10.748 y ��u 0 00000 0 = 0 > E0
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O. Y RI04, Date Rec'd
N CITY OF PRIOR LAKE
'" 4 SEWER AND WATER PERMIT
s ljA'NEsoo
1. Green File PERMIT NO .
Yellow City /0. 74
3. Gold Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 6 Z 2 0 sa p•cku( Avt- s;E.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Na `�1 A,4&' S + 1.f1 C 4445 L X11''' lc (Phone) 44d• g3 1 S
(Address) .. 6'
(Address) (City) (Zip Code)
APPLICANT
(Name) 4 G &' J c� �lv 494 0 1-'3 (Phone) 95'l - 4 37g 2..
(Address) P.o . t o 4 CZS7 P!l or Cetk<- SS 7 Z
(Address) (City) (Zip Code)
(Contact Person) 0-4- ` (Phone) 6 lz — 6 ? Z
APPLICANT SIGNATURE DATE a /e/ //2)
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches. .sewer to ._ l,AZecd -o c Coles Nzt- 4 • re
Location of any couplings from structure feet. Quell' Eo ct sewer
Type of sewer pipe. EJ ABC ❑ PVC ❑ Cast Iron
M.).--( Estimated length of sewer line $ 25 feet. -! a2s'c pu..p L c 61 Y
Clean out (if required) located at 9 feet from structure. Sewe -ti
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 $ ID, coo Building Permit #
SEWER AND WATER PERMIT FEE $ 4°..S0
STATE SURCHARGE $ .5.00
TOTAL PERMIT FEE $ 54. S
(Office Use Only)
This Ap is ' Becomes your Building Per t hen Approved Paid 5 , ` e eipt No. i3
Date p / , /0 y
Building Official ate •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
0 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
NES
1. Blue File PERMIT NO
3. Ye
2. Ye City
App licant ( _ ict
Yellow 1 �(J
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I6 2 id s+ f ,.�� 4 - s.E .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
O
(Na VA's' t l C - -- 7AJ ( [..J c.,4 (Phone) 110 • `
(Address)M
APPLICANT
(Name) 4 IS0e.. vat" 5 11 u n 5 r (Phone) 9S Z 4 y is 377
2
(Address) P 0 soy 12 S 7 Q (r SS 7 Z
(Address) (City) (Zip Code)
(Contact Person) J (Phone) 61 7 — 27° • Gd 7 'Z
APPLICANT SIGNATURE DATE 8. / 7 / /fa
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other fla t ) mower Ls 1 - fl) i c4
ck
C t Je•G C �r h.
FEE SCHEDULE
Industrial, Commercial & Multi - family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ f 0 ,00* Building Permit #
PLUMBING PERMIT FEE $ 2 5 . So
STATE SURCHARGE $ .50 0
TOTAL PERMIT FEE $ 30. Go
(Office Use Only)
This A 'c : I n Becomes Your Building Per , 1 it 'hen Approved Paid 3 U . 50 Receip . a 1 /0 Date By
Bu ding "s l ate 7 , /0 • l 0
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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