HomeMy WebLinkAboutSewer & Water Permit #09-0934 �c� p�o� " Date Rec'd
F 9 CITY OF PRIOR LAKE
"' � SEWER AND WATER PERMIT
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'. �" F '`` pERMIT NO.
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ADDRESS ZONIl�TG ��,�>
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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APPLICANT SIGNATURE DATE � l �� D� 0�
APPLICANT PLEASE COMPLETE BELOW
Size of water service �_ inches.
Location of any couplings from structure feet. � �
Type of sewer pipe. ❑ ABC � PVC ❑ Cast Iron �
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
FEE SCHEDULE
Residential sewer and water line connection $51.50 Industrial, Com'1 & Multi-family 1% of job cost with a$51.50 minimum
Sewer connection only $25.50 Water connection only $25.50
Estimated Cost $ Building Permit #
SEWER AND WATER PERMIT FEE $ P� � u ' p�szwv�,r
STATE SURCHARGE $ .50 q p
TOTAL PERMIT FEE $ � I � ! � ¢
�ot��e u� o�y .
This A r uilding Permit en A roved Paid Receipt No.
� Date By
BUiI E O�1 8tC
24 hour notice for all inspections (952) 447-9850, faa (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372