HomeMy WebLinkAboutSewer/Water Permit 01-0464
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
1. '""" FiI, I PERMIT
2. Yellow City
3. Gold Applicant
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ZONING (offi<e us.)
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(Please'!vpe or orint and siRn at bottom)
ADDRESS
3 J- ~O 'Todd Rei.
LEGAL DESCRIPTION (office us. only)
LOT IT BLOCK ADDITION 12 LS I a...q
PID;;;- ~ :Xt..- 001-()
OWNER
(Name) f:'r'-.- ...
f ,1\. ,"_Ie"",
(Phone)(9S~ 4'1'7- 'I4.J..:;;J
(Address)
3~l1'<l "ffJr/4. fJ...J
(Address)
P'f'lDY"" L<.r I~.,..
(City)
Ss,??J...
(Zip Code)
APPLICANT
(Name) Rd 4-0
(Address) 1'f...~ 10
R()"~'t!"-r
~771-1- .all.-
(Address)
(Contact Person) ~..c" tn' <:-r......
APPLICANT SIGNATURE Q. .JJ-t
I
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches. ......
Location of any couplings from structure feet. {<.c, p~.....
Type of sewer pipe, 0 ABC 0 PVC i11' Cast Iron
Estimated length of sewer line feet. t1
Clean out (if required) located at feet from structure.
(Phone)
5S~-1'\~:2.
.A. )
(City)
cdl
(Phone) ~/J. -<:<;7- /-.'7'UA
DATE S-Ili'-ol
(Zip Code)
Residential sewer and water line connection
Sewer connection only
FEE SCHEDULE
$35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
$17.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
1'l,5"D
.50
10-,00
(Offi.e Use Only)
Building Official
Paid 1?,cJO
Date Ic;J
Dat. .5/ 10/ 0 I
24 honr notice for an inspections (952) 447-9850, fax(952) ~7-4245
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By fjC
This Application Becomes Your Building Permit When Approved
CITY OF PRIOR LAKE
INSPECTION ."'OTICE
SCHEDULED
DATE TIME
5/ &f!L ~
(? .'c()
ADDRESS
ga~o
~dd
OWNER
CONTR.
PHONE NO.
/-J/~l/
I
o FOOTING 0 PLUMBING RJ 0 EXIGRADlFIUING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL 0 PLUMBING FINAL 0 GASLlNE "IR TST
o SITE INSPECTION C 0 MECH FINAL . 0
COMMENTS: N tJ~ ~
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- II
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PERMIT NO.
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Inspector: Owner/Contr:
CALL 447-985~ tOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS AIlE FOR YOUR PERSONAL HEALTH & SAFETY!
JN9NOTI