HomeMy WebLinkAbout90-057l
OF P RIOT
.CITY OF PRIOR LAKE
SEWER AND WATER PERMIT NO. O.5�1
NOTE: Sewer and Water
1 +:
contractors must`
f
be registered`
with the City.
APPLICANT: �i2 .S 1� PHONE: 1 4 Lk
ADDRESS: C/ a C2 �L �7 DATE:
SIGNATURE: CU P�yJ S i I � '
U- BLDG. PERMIT #
{
SITE ADDRESS:: / /J C �7_� W�V� PID# PS
w .
FILL IN THE BLANKS
1. Estimated length of water.service feet.
;
2. Size of water service inch(es).
0
3. Location of any couplings from structure h 6 — feet. t
`
4. Type of sewer pipe. ABS_ PVC Cast Iron_
5. Estimated length of sewer line /S feet.
6. Clean out (if required), located at 90 feet from
structure.
This applica ion becomes your permit when approved.
} I r
BY _ G�W� -- DATE • It 7- '70
FEES ": $ 35.00' Sewer and water line connection permits
$ .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 AMOUNT PAID
RECEIPT # RECID BY
4629 Dakota St.' S.E., Prior Lake Minnesota 55372 I Ph. (612) 447.4230 J Fax (612) 4474245