HomeMy WebLinkAboutSewer/Water Permit 03-0092
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CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
Date Rec'd
/~ 24 -()3
\, Green File PERMIT NO I
2. Yellow City ''l'17_ ot~?
3. Gold Applicant V"") V ~
(Please type or print and Si211 at bottom)
ADDRESS
/St,02- PISH ,or: 1<::dO.
LEGAL DESCRIPTION (office use only)
LOT 4-BLOCK I ADDITION
OWNER
(Name)
(Address)
7JI6 ~...J
(Phone)
(Address)
(City)
ZONING (officellse)
~I
PID2..)- 2/R 7 ~c.P'f-.'<-)
(Zip Code)
-
~:;~fANT /I)~ 10 - R /)01-< r (Phone)
)LjS~Q a7~ rive II), 11\ yVl 0 v'/h
(Address) J (City)
(Contact Person) !tv! J '/k + A (Phone) ;Z' 5- 511- 57Yf
APPLICANT SIGNATURE ~.JtJ~ DATE /-Q)Yo~
(J
APPLICANT PLEASE COMPLETE BELOW
(Address)
7t"3 $Stt -3SJJ...
r11/J
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
Residential sewer and water line connection
Sewer connection only
$35.50
$17.50
FEE SCHEDULE
Industrial, Com'l & Multi-family
Water connection only
(Office Use Only)
I % of job cost with a $39.50 minimum
$17.50
Building Permit # 03"" 0 0 17--
,
/7.SV
.50
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Estimated Cost $
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
paid; i. l/D
Dati
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
~S' 'Ii( J
(Zip Code)
Recei(J~3 1
By
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED I-~~
/500 ~ /'>>L jJ~ 72J
CONTR.
PERMIT NO.
3./Cjr
o PLUMBING RI 0 EX/GRADfFILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GAS LINE AIR TST
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o WORK SATISFACTORY. PROCEED
? CORRECT ACTION AND PROCEED
o CORRECT ~O:KffLL FOR REINSPECTlON BEFORE COVERING
Inspector: V 111' I-L 7 ,OJ Owner/Contr:
. -
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl