HomeMy WebLinkAboutSewer/Water 02-0669
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CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
Date Rec'd
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I. Green File [ PERMIT NO
2. Yellow City. . ~z. -vL L. 7
3. Gold Applicant C7 ({/
/&4-30 PUL---U77-! A1/6. J.
ZONING (office use)
~2-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
~/c;l Nao{~ DTJ"
(Phone)
(Address)
(Address)
(City)
(Zip Code)
APPLICANT
(Name)
7'3- <~:> " - L?~ad
'''/
(Address)
(Contact Person)
(Phone)
DATE
,~ (..-C)~
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
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
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 # O?- - 6 /; ~ 1
,
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ /7. .>0
$ .50
$ /B . (t U
(Office Use Only)
This Application Becomes Your Building Permit When Approved
PJ1iA4- l - & / c-Z--
Building Official Date
Paid
.{llJ
Da e / . ;7
y .-r;, - P' e:..-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245