HomeMy WebLinkAboutS/W Permit 06-0102
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Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
~~~:w ~ii~~ I PERMIT NO. O~. 0/02 I
Gold Applicant
ZONING (office use)
R. I S.D
~+ KeNT STe€€/
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
/Ole Waoo
PID 25. f()3. 00 .
OWNE~ ~l
(Name) U ~ I t le_ V
(Address) 33) 4
(Address)
(Phone)
(City)
(Zip Code)
APPLICANT
(Name)
(Address)
JeCH€
(Phone)
(Address)
(City)
(Zip Code)
(P/Z-. 7zD. 7~.s~
(Contact Person)
(Phone)
DATE
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
$17.50 Water connection only
I % of job cost with a $39.50 minimum
$17.50
Estimated Cost $
Building Permit # 6 G 0/' l-
SEWER Al II? .J.l" .1.1it PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
/7. 50
.50
/8.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid . 17-,
/2 ('0
Date .' " I
Z.t.5,{,1c
Receipt No. 5// Cl
By / t:;7
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245