HomeMy WebLinkAboutUtility Connection 15. 1371 Z ZEN-- U
J W LL cc z 6�t
L-7- 161161R W W Q >
U U W
sg5g =_ °�
aaag z z ��,
w Oa � � a w cn
WOu u C9 >O S c,
o• us
00 ❑ ❑ ❑ ❑
U
W =
j
O ` N Zo
LL Z �C
co ' 0 W
aaz z U E- a,
W p > > Q o U oG
ii,
a Z Y Y Z a`� w '7 0
O F_ O O LL Q W co z
O z ce O 0 0 z z a z
•
LL F
U , a m S W S $ S W W
CO U a. 25toa. W WS W
Z
ag3Na2 � w i
0000 ❑ ❑ o a 0 H -i
P' O Q U OLL
0 /� U p Y o W
u Q — re m
in z4
Y U O N Q o r W
~ z ui vi a E- E- 4 44
a' Z O W H N W W J q
O = C7Q0 � N Z a S o Q
d N z Z O = J J ? W 0 0 0 y U v
U
co) S W O O O Q W U U a
W tozw
0 Z 00 O O LL 2 LL Q ❑ ❑ c
a 0 a 0000 0 V
W Z 0
J - liZ
►- JQ: ct
,
LLZza
U
ggUU
5s ` z
Nt
w>w l U 2 WW u 4' )
I-
<
' w ❑
('/ U lL 0 v W Z t.t..,0000 ❑ ❑ -
•
, 1, A4
NO
p
J O aa -+ u )4I C
Z » Q • r W w Z
t F V
W V
VIdHI
7 1 '' o O
. 4 1 --I �` d a O 2
_I Lu a
I d 2 N a 2 ! cl) 00 W W x O
il ❑ El ❑ ❑ , 3 ti
�� U U 111
Z W
c\''
u a a LL H
�: ❑ J
YW Q a 0 w
U z z U U.
H S U 0 Y
Z z z v to C l^ `
O c7 O O a i„ 4 �� ' i s r: 01
u. � u) zz z0Zg z w �' +' ' V < 0 0 a
co U U
}OW W Z 0 ❑ �h < W \y ce re •o Q q
c% 3 O Ou.Ou.z �iin 0 0 0 0 V, U U
a a O a 000000 V -& lr' J" ri ":11, * 3 U U h
�.� % ❑ 0 c
SCOTT COUNTY, MINNESOTA
INDIVIDUAL SEWAGE TREATMENT
l SYSTEM (ISTS) PUMPING P # 39335
Owner i A r/, - r _ EnRMIT
Pumper f��C Address f 70 7 G /y l /1P/6z..
No. of Tanks Pumped �� `�
Total Gallons Pu
❑Commercial
all that apply: Residential,iiigeptic ❑Holding um Chamber
Condition of Baffles (baffles must be inspected)
p ❑ Cesspool bandon .�
Acceptable oLJ Other:
Depth of sludge layer ❑ Unacceptable '
�_inches ❑Rei la�ed Baffles
Disposal Location (be specific) r
Did you observe a surface r"
charge? ❑ Yes
)
Pumped From: �No
❑Mainte ance Hole Removed Tank Lid (stave, for example)
I have been informed about the correct tank cleaning procedures ,
I thev tank is not pumped through the Maintenance Holet I 0 Inspectionysystem
to Pipe(see batuwl
/Tank Lid enable the removal of solids.ving mY system fail prematurely
Signature of Owner/Owner's Agent
Reason for not pumping through the Maintenance Hole/Tank Lid
Comments ,
Pumper/Inspector Signature •` ,
Only one permit is needed ,- �'r-i
per ISIS.If thee: mOre than one ISYS on a property, Date_12_ _/c
Submit a permit whenever a tank is pumper for abardonment''pumpi� the tank submit a separate permit for each ISTS.
p p
nk does not constitute a compliance inspection.
White-County -`�.
Canary-Homeowner
Pink-Pumper
Form#1120
....Ai
• /„ LSCAV Brad Overby
••• " J Engineered Wood Market Manager
• • 2871 W.Service Road
•
St Paul,MN551
21
• a (612)803-1580
BueLlnX • 91 Fax x
( / brad.overbY@bIu:Iiflxco.com
\ --1(S1 5 ii\4.5.
r. ' .,4
6
e-'z
9...:///)
‘13 —•
cs
I
""•
/
• w
Y
Nil >
NAME: DATE: BY:
COMPANY: uINEb PHONE NO:
LOCATION: FAX NO:
Atik Georgia-Pacific
y 1'Ri4 City of Prior Lake 0RECEIPT
.y 4646 Dakota Street SE
1 7 Prior Lake MN 55372
a, /;4
r ,x 952-447-9840
Receipt: 3356
Received Of: Date: 11/06/15
Timothy Kadrlik Customer: Timothy Kadrlik
17075 Maple
Prior Lake MN 55372
Receipt-Item Item Receipt Descri tuo ,,. ,' GL,(umber Total e � s=� � � �
Utility Connection 15-1371/17075 Maple Ln
SAC Fee 2,485.00
Water Meter 560.00
Pressure Reducer 180.00
Water Connection 900.00
Sewer Connection 600.00
Water Tower Fee 1,000.00
Plumbing Permit 15-1371/17075 Maple Ln
Plumbing Permit 49.50
State Surcharge-Plumbing 1.00
Sewer-New Construction 15-1371/17075 Maple In
Sewer Permit 51.50
State Surcharge-Sewer 1.00
Receipt Total 5,828.00
TENDERED: Checks 491508 5,828.00
Total:5,828.00
of PRio CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
X AND UTILITY CONNECTION PERMIT //, j . /,-
0•,A'NE50�I: I. White File
2. Pink City PERMIT NO. /5"; 13 7/
3 Yellow Applicant �`/ T
(Please type or print and sign at bottom)
ADDRESS1 -7D7S- &WY g (k( ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ,715---,220-065-o
TIMOTHY J KADRLIK
OWNER
(Name) 17075 MAPLE LN SE (Phone)
(Address) PRIOR LAKE MN 55372
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ['Deck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ •
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished i. i•on on t,is application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the
abov entioned pro.crty and to 1 con•ruction ill conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
office an revoke th. ,-rmit'erj .t cans: Furthe ore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $ .744 °t`�
Plan Check Fee $ Water Meter Size 5/8";p $ t9I q J Iw
State Surcharge $ Pressure Reducer $ /g0
Penalty $ Sewer/Water Connection Fee # $ I G fy� l
Plumbing Permit Fee $ i-/1 D Water Tower Fee # $ / nJc2
Mechanical Permit Fee $ •�/ Builder's Deposit $ [ (J
Sewer&Water Permit Fee $ SZGD Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ .�
This Application Becomes Your Building Permit When Approved Paid Y 00 Receipt No .4'.
Po
Date if. 6 , /5. By 3 S�
Building Official Date J
This is to certify that the request in the above application and accompanying documents is in acr ance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allAvs construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake,MN 55372
v , pRJ0 Date Rec'
�eCITY OF PRIOR LAKE PLUMBING PERMIT 4 ,
4ifiA NEsiso I. Blue File PERMIT NO.
2.Cold City 6-, /3
3. Yellow Applicant ( ,,,////
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
17 '7 - M 'C C Ki
LEGAL DESCRIPTION(office use only) ( 1 �,r
LOT BLOCK ADDITION PID R, --- 7 �-�-'-"'ce .46
OWNER TIMOTHY J KADRLIK
(Name) 17075 MAPLE LN SE (Phone)
(Address) PRIOR LAKE MN 55372
i
APPLICAN ¶• / p) - f'? 4,,,,_,._,t
( (Phone)
9 c--, _ ? o .. cL7 3
(Name) (,� V ✓'^ t�i ��n;<<( Phone
(Address) /7o U mu51,14-, ., )2 I / Pr,`0-. LA r e_ 5 3 �`-
` (Address) (City) (Zip Code)
(
(Contact Person) a'-ie../e.... ` t -'".4\ (Phone) `1 S u�— 3 )O --`j 6 7 3
APPLICANT SIGNATURE DATE /0/i 3 0 / Ole/5
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher _ Water Heater
Floor Drain _ _Water Softener
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit#
PLUMBING PERMIT FEE $ rF i o+�tl"Y'i..
STATE SURCHARGE
TOTAL PERMIT FEE t':- .4'.1•,;
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
(I, PRIO Date Rec'd
x CITY OF PRIOR LAKE
�� SEWER
AND WATER PERMIT
4.*NNESO2.
I. Yreellel
reen FileCity PERMIT NOfc /37
3
(Please type or print and sign at bottom) s. Gold Applicant
ADDRESS ZONING(office use)
t7DS AO 4-P16 &kit
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER TIMOTHY J KADRLIK
(Name) 17075 MAPLE LN SE (Phone)
(Address) PRIOR LAKE MN 55372
(City) (Zip Code)
APPLICANT
(Name) (Phone)
(Address)
(Address) (City)
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. n ABC n PVC I I 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'!&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 $ l ne ivilnnesota statutes$.5LbB.l4ti
STATE SURCHARGE p i fi "SURCHARGE"has been extended
TOTAL PERMIT FEE RA. !. pl The minimum surcharge for a
"r1 iz3 "fixed fee" permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid —. ` Receipt No.
Date By
Buildine Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372