HomeMy WebLinkAboutSewer Permit 01-0492
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
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Date Rec'd
.. 2 3 2001
LEGAL DESCRIPTION (office use only)
LOT 3 BLOCK ADDITION
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Green File I PERMIT NO d. ~
Yellow City. .. .. ~,.' L/Q
Gold Applicant. .; r - "7 / I
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..J( . . ONING (office use)
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(Please type or print and sign at bottom)
ADDRESS
1/, '37t;
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OWNER I -
(N ame) _._..J-. z..
(Phone)
(Address)
(Address)
(City)
(Zip Code)
APPLICANT
(Name) P fl.. .f S tl6A... l:... X. C.
(Address) I ~ If P .:t-c F L ~ '11 I't '-I
(Address)
(Contact Person) ($ ll. t- (. IJ
APPLICANT SI(JNATURE e-L+ <i'\ ...-..o-L_
(Phone) 9 r J-
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L Ail.G ,,/1:t. lIE.
(City)
(Phone)
DATE
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(Zip Code)
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APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure
Type of sewer pipe. D ABC D PVC
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
feet.
D Cast Iron
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
$
$
$
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.50
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(Office Use Only)
Building Official
Date
Paid /g ,OU
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Rec~t qOb r;)-p
By
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This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245