HomeMy WebLinkAboutSewer/Water 02-1282
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10/07/02 lION 09: 16 FAX 6124474245
_. __- _ _._.______ __ ~TY OF PRIOR LAKE
tlJOOl
Date Rec'd
CITY OF PRIOR LAKE
SEWER AAl> WATER PERMIT
/{)-1- 0 Z-:
l. c.... 'ill I PERMIT NO I
~. YII~" ell}' I . tJ Z -- 12 e z.....
J. Oold AfI'Iloanl ,
('''''" :r"'. -;;_mJ
r ADDRESS .
{[} Lj; 1'1 ~' r; 11. ~
L '
ONING(officc_l \
!if~
LEGAL DESCRIPTION (oma U$e only)
LOT BLOCK
ADDITION
PIO
OWNER
. (Name)
(Address)
(Phone)
/r /tJ,1. L/I..
(CiM
J--~L/7-
(~ip Code)
DATE
~~f?~1: 1',
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Lo~ of any couplings from strUcture_ feet.
t/rYpe of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line _ feet.
Clean out (if required) lo()ated at _ feet from structure.
Residential sewer and water line cQMeetiotl
Sewer connection only
$35..50
$17.s0
FEE SCHEDULE
Industrial, Com'l &. Multi-family 1% "fjob cost with II $39.50 minimum
Water cOJ'lnection only S 17.50
Building Permit # () 2. - /Z.g; z-
$ L7..57J
$ .S~
s -Ie;.. eft]
Estimated Cost $
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Ofti~e Ust OaIy)
iO-7-rJ'L
Date
Your Buildine Permit When Approved
24 hour Ratite for alllnlpettions (952) 447-9850, fax (952) 447.4245