HomeMy WebLinkAbout90-059U
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT No.
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT: L �3�iE�Q PHONE:
ADDRESS: DATE:
SIGNATUR i� BLDG. PERMIT #_ _
SITE ADDRESS: ",,.- Nr� PID #' � — 0
FILL IN THE BLANKS
1. 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.'
f This a licati ecomes your permit when approved.
BY < —A�100 DATE: Z�
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 �Jd AMOUNT PAID
RECEIPT # REC'D BY
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612)447 -4230' t Fax (612) 447.4245