HomeMy WebLinkAboutSewer/Water 03-1396
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Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
~. ~~~:w ~ii~:, I PERMIT NO.O 3.- /3 9(-1
3. Gold Applicant - ftI
.
ZONING (office use)
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IJU6U1J!
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LEGAL DESCRIPTION (office use only)
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LOT 12BLOCK ADDITION ~
OWNER
(N ame)
(J tJ.
s- r-
- AOD\ rk)!'i
PID 25 - Zb't -<2)1 -0
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(Phone)
(Address)
(Address)
(City)
(Zip Code)
APPLI9ANT SIGNATURE
(Phone) 0~/-i80-g~7~
(KJ..B:k6/&, /(4sT/~vG5,.I-1N 5"'~o3~
(City)' 01 2, . '7/1-. ? 1'1" Code)
(Phone) ~/2 -I /7~' 1)7 II
APPLICANT " /, 1/ A r -
(Name) /V'O/L/:}. - 1/&)5; :rAJ&
(Address) Z ~L.J7 e.,()m~r<:-L- fJ eil1t-
~#~Jil., S.f
(Contact Person) , ~
DATE
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure _ feet. C ~L-
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron iN ,-
Estimated length of sewer line _ feet. \) AJ''-.,'
Clean out (if required) located at feet from structure.
Residential sewer and water line connection $35.50
Sewer connection only $] 7 .50
FEE SCHEDULE
Industrial, Com'l & Multi-family
Water connection only
1% of job cost with a $39.50 minimum
$]7.50
Estimated Cost $ B ~/ 4co .- Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
&h4---
$ .50
') , $ ~,S-O
L! I/}. . t,1 I'v ') J .A ~ . I
'fIlM-" f1:)fI'.IV JI ~/()~
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
10 /;4 /0 3
I Dale
pai~4- . ED
D,7. ~. 03
24 hour notice for all insp~ctions (952) 447-9850, fax (952) 447-4245
FROt'1 :
FAX t,IO.
Dec. 13 2003 02:49PM Pi
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Instrumental Research, Inc.
7800 Main St. Fridley, MN 55432 763-571-3698
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December 11, 2003
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Stillwater Testing, Inc.
587 Quixote Avenue North
Lakeland, MN 55043
LABORATORY RESULTS - WATER SAMPLE 13789-1616.,
A water sample from Nova Frost construction site: U.S. Post Office. 16887 Duluth Avenue SE.
Prior Lake. MN was submitted to Instrumental Research laboratory and tested under my
supervision. The sample was collected by Stillwater Testing, Inc. persoIUlcl.
EPA&MDH IRI Analysis
ParameterlMethod Results Drinking Reporting Date
Water Limits Limit
(Total) Coliform Bacteria Absent Absent Absent 1211 0/2003
9223 B. (P-A) Method
These results meet Enviromnental Protection Agency (EP A) and Minnesota Department of
Health (MDH) standards for a safe drinking water source.
All analyses were performed using Standard Methods for the Examination of Water and
Wastewater, 19th edition EP A approved methodologies.
Report submitted by,
~~.~
SUZANNE MELCHIOR, LABORATORY SUPERVISOR
SM/ak
Minnesota Department of Health Certified Laboratory No. 027-003-130
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