HomeMy WebLinkAboutS/W Permit 94-0014 GREEN - FILE
O � P R j0� " re«ow - ���r
� � oa.n - aTr
C�v �
� x
�
CITY OF PRIOR LAKE NO. ��
� ES �.SQ' SEWER AND WATER PERMIT ,
NOTE: Sewer and Water
contractors must
be registered
with the City. "
APPLI CANT :�� -/COm �� PHONE :�y 5 � 3 5 Z Z--
ADDRESS : /� O 27 � 1Qve� "�'✓� /s , 3 �� DATE : 1�5� ��/
S IGNATURE : - � , (01''� BLDG . PERMIT # _ — � �"
SITE ADDRESS: � S 75� J'�'�/��a.r S/� PID# �� (�OU /""d
FILL IN THE BLANKS -
1. Estimated length of water service feet.
2. Size of water service inch(es).
3. Location of any couplings from structure feet.
4. Type of sewer pipe. ABS PVC Cast Iron
5. Estimated length of sewer line feet.
6. Clean out (if required), located at feet from
structure.
-------------------------------- --------
-------------------------------- --------
This application becomes your pe CLOSED DUE TO
INACTIVITY 8/30/Ol
BY
------------------------------------------------------------------
------------------------------------------------------------------
FEES: $ 35.00 Sewer and water line connection permit.
$ .50 Surcharge
$ 35.50 TOTAL
* Fee for either s.wer or water individually $20.00 plus
. .�s_u�rcharge . ,
* Se ermits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID ,L��I�9� AMOUNT PAID .�
RECEIPT # �(� �(e � REC' D BY
4629 Dakota St. S.E., Prior L.ake, Minnesota 55372 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUN[TY F�IPLOYER �