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HomeMy WebLinkAboutSewer & Water Permit 15. 0212 0 1N z _ ui OZUVW Z w t ` O � WwN G ` Z �. f, Qa'cea z Z C) LLu. 0w ° .Ip !c 000000 > a 0 o v oWc = 0 N m L.: Z J 0 W 0 •0 » < z oQ V 4, _I m 0 0005. 0F= d a s r G OOC9a U CoC W X Z z ?al II. W 0 A C.) �� V a m = W6 � V W 0w z 1t, r ,njWs.cjJW W W - W �y \\CS a23v� a2 c� z oC ❑ ❑ ❑C 0 ❑ a nU. a a I J Q u- W � o Z Y � 0 Y � o LL 1- 0 T O Z •z H n ... W oi 0 ct zz Ci O O d Z i P to ,Lu W W J q ua.. ix ce O N ce W 7Z2� <z 2 O p p O V O W cela W Z 0 0 CO Z 2 0 0 0 va 0 0 u.0- u. ELLco O ❑ 0 c z < 0 a 000000 V DA `" ` ° CITY 4F PRIOR LAKE Date Reed (.0) 0 v SEWER AND WATER PERMIT $s3 i r . • , or,riot and si_n at bottom ! ctT�, €�k 'lease 2. YL71 c; PERMIT NO. ADDRESS 3. Gold Applicant V �J� /Z r. A s * ', ©NIl�TG(okiceusel LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION OWNERPID (Name) , (Address) (Phone) (Address) 0 APPLICANT (City) (Zip Code) (Name) \ i ' (A(Address) a it (Phone) 932 9i t (Address) .f . ; " (Contact Person) k„ l (City) Al (Zip Code) APPLICANT SIGNAT (Phone) -/ 2 J 2` 0 �C mely /!,.r- _, DATE --.1t111-:11.__________��- APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. Q ABC [l PVC Estimated length of sewer line feet. Cast Iron Clean out(if required)located at feet from structure. Residential sewer and water laic connectionFEE SCHEDULE Sewer connection only $51.502IndWater octMulti-fatuity 2 ofjob cost with a$51.50 minimum $25.50 Water connection only Estimated Cost $ , $25.50 C—0 Building Permit# SEWER AND WATER PERMIT FEE $ 2- 5 5-0 STATE SURCHARGE TOTAL PERMIT FEE $ C ` (Office Use Only) This Application Becomes Your Eufdlitg Permit When Approved Paid 3 0 Receipt No. 8 1Liar 3uiidtna offlclat Date 3'--; .--- i! L S 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.I.Prior Lake,Minnesota 55372