HomeMy WebLinkAboutSewer/Water 02-1467
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11/06/02 WED 12;25 FAX 8124474245
CITY OF nIOR LAKE
[t.J 003
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
Date Rec'd
J 1.1- oz--
~ =. ~\~ I PERMiT NO. () 2 - / 4~ r7 I.
,. CiIW ~plll-. L .
I~-;cr:: Pr-iOf' /J!ke ,Mt-0 5S01d. IZONlNG-",,]
LEQAL DBSClUP'I'ION (0. '* oaly)
LOT BLOCK
At>DXnON
PID
=;r~~1 ~.f'r POOr bak- !PhoD<) q5~ ~;:n'L
(Address) ( (Zip
APPLI~ ' " U If)J L
(N"""'LG~*~ ed<JG. ..ful' ..::w~'5 I -:me. . (I'II<>D<) D!'i 1- :J;). '" - vn IR \D
(Addxull) ~- o. l o~ 39..1 l-l ~t) ~ 5563 <6
(AddRsI) ( (Zip Ccldc)
(ContaCt Person) ::r ~ V le,br~ (phone) ~ - ;:).<h ~ - 3dQlD
APPLICANT SIGNATOllB DATE ""0 V. le,. aOo.;l
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches. .
Location of my couplings from structure. feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Bstiltlated length of sewer line feet. .
Clean out (ifrequircd) located at _ feet from strUcture,
FEESCRJr.DULE
~ickm~ia1 sewer and water line connection S35.50 IDdwmial. Corn'l & Multi-&mily 1 'Yo Qf job ~t with a $3'.'0 miaimum
Sewer connection only $17,50 Water cOlllleetioa only $11.50
Estimatecl COlt S
Building Permit ~
Ol-/4~7
(1.50
.50.
/0. (JQ
SEWER AND WATER PERMlT FEE S
STATE SURCHARGE S
TOTAL PERMIT I'D S
(om.. v.. o.~)
Tbio "'Pl..... com.. Your hilding P.rrillt Wben Approved
~.. /I' -7- () Z-
BlIildi_. 011"_. 0.$1:
Paid {
e) o[)
Oat
CL--
ReCeipt No.
43;; 4-"0
9)'
/'
Z4 hoar notice for all in.pKtiona (952) 64'.9150, rax (951) 447-42.45
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