HomeMy WebLinkAbout90-060--� CITY OF PRIOR LAKE
SEWER AND WATER PERMIT No. -�.
NOTE: Sewer and Water
contractors must
be registered
with the City. ,
APPLICANT• D S.9P / -I GIPS PHONE: 1 19 , 6 - 1605
ADDRESS: 9' 316 H,4,, QTR DATE: //- 2 G _So
SIGNATURE : 4 p BLDG. PERMIT #
SITE ADDRESS. S316 A/441NA" PID# .R -068= 001 -D
FILL :IN THE BLANKS
1. Estimated length of water service FU 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 fine c � U feet.
6.. Clean out (if required), located at feet from
structure.
This app ication becomes your permit when approved.
BY fi /fihca DATE:
0
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 AMOUNT PAID s �
RECEIPT # /�dZ�� RECID BY
4,629 Dakota St.1S.E., Prior Lake, Minnesota 55372 I PK (612) 447.4230 1 Fax (612) 4474245