HomeMy WebLinkAbout90-047i
PR10 B
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT NO.
NOTE: Sewer and Water
contractors must .
be registered
with the City.'
APPLICANT: & PHONE:
ADDRESS: DATE: /O - /D_ �d
SIGNATURE: ZLDG. PERMIT #
SITE "ADDRESS: 5�,:'� ( r? ? T ID# 6 I p
FILL IN THE BLANKS
I. Estimated length of water service feet.
2. Size of water service inch(es).
3. Location of any couplings from structure feet.
4. Type of sewer pipe. _ABS PVC Cast Iron_
5. Estimated length of sewer line feet.
6. Clean out (if required), located at feet from
structure.
This Ication bec omes your permit when approved.
DATE:
FEES: $ 35.00 Sewer and water line connection permit.
$ .50 Surcharge
$ 35.50 TOTAL
* Fee for either sewer or water individually is $20.00 plus
"$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued
DATE PAID - _y ^ d AMOUNT PAID
RECEIPT # �6os -9 RECD BY �J
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 1 Ph. (612) 447•}230 / Fax(612)447-4245