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CITY OF PRIOR LAKE
SEWER AND WATER PERMIT NO D/
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT: jLILIc /44S7_/N PHONE:
ADDRESS: ZgI14 8-5 1--1 C -,A)C A k , DATE: / 11P4
SIGNATURE: � qq BLDG. PERMIT #
SITE ADDRESS: l gllq j7Sf7
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.
This application becomes your permit when approved.
BY to DATE: ,1'"026 —P )
FEES: $ 35,00 Sewer and water line connection permit.
$ .50 Surcharge
$ 35.50 TOTAL
* Fee for either sewer or water individually is $2.0.00: 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 # )e ;26, f RECID BY �A
4629 Dakota St. S.E,.Prior Lake, Minnesota 55372 I Ph. (612) 447.4230 1 Fax (612) 447.4245
0
m
DATE TIME
CITY OF PRIOR LAKE CALLED -IN
INSPECTION NOTICgf � _� , SCHEDULED
9
PERMIT NO. 9 � COMPLETED . ao
_/ O —C.l
ADDRESS i < �S� C
I`T L�=
OWNER
CONTR.
. TELEPHONE NO.
W O FOOTING OPLUMBING RI -
OSITE INSPECTION
O FRAMING O MECHANICAL
h O INSULATION. ATER HOOKUP
O EXCAV./GRADINGIFILLING
O LAKESHOREANEfLANOS
O WALL BD. METER SETITURN ON
O COMPLAINT
2 O' FINAL -SEWER HOOKUP
O FOLLOW -UP
Q O PROGRESS q SEPTIC INSTALL.
O SEPTIC FINAL
y
2 O DEMO 0 SEPTIC MAINT.
J L'
'❑ FIRE PREY.
O FIREPLACE
❑ PLUMBING FINAL.
C OMMENTS:
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W O, WORK SATISFACTORY'PROCEED
,, ���gg // �,�CORRECT
O PHOTO TAKEN
WORK AND PROCEED
ULy,CORRECTWORK. CALL. FOR REINSPECTiON BEFORE COVERING
Ell CORRECT UNSAFE CONDITION WITHIN HOURS. INSPECTOR WILL RETURN.
• STOP ORDER POSTED. CALL INSPECTOR.
• INSPECTION REQUIRED. CALL TO. ARRANGE ACCESS.
-
oall for the 4 hours in advance.
Owner /Co
Aoe
Inspector
447- 4230'
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