HomeMy WebLinkAboutS/W Permit 07-1134
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CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
Date Rec'd
/127.0;
~ ~:~~w ~ii~~. I PERMIT NO. 07 //:.3 A~
3. Gold Applicant. -::r:=J
ZONING (office use)
[)/J ~T(l7 -5f:
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER j) ~"'~ &~ tf5',;J.- 'ftf 7 5' /f~f-
(Name) (Phone)
(Address) JfI(I Q j)tLl< (j f fA.. ,6/ f;-.,; 'tJ y I..-*- ?5'37::L
(Address) (City) (Zip Code)
APPLICANT
(Name)
(Phone)
(Address)
(Address)
(City)
(Zip Code)
APPLICANT SIGNATURE
4/
L.:-tf.t.....-y-yt.-f/t-tt
(Phone)
DATE
(Contact Person)
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure _ feet.
Type of sewer pipe. D ABC D PVC D 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 #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
/7.~
.50
If}, () ()
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid ;8, 00
Date;/. 2 7. 0
Receipt No. 55 ()C, 0
By
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245