HomeMy WebLinkAboutLA024235 ITY~° F EVI PERMIT TYPE: PEWEE ~ WATER
2095 HOLYOKE AVE. ®P.O. BOX 957 X24235
Lakeville, Minnesota 55044-8012 Permit Number:
(612) 469-4431 Date Issued: 03/1?/93
SITE A RESS:
15020 OI~TST~.L HILLS LA
LOT : 1 BLOCK : 1
CRYSTAL LADE Gt~LF ESTATES 2NI) AI}€? I T I OAT
F , I , ~ - ; ~~-1 ~5~.a5~01~i-O~,
®ESCRIPTIOIV:
Sewer ~a Water Permit Tv~e S/W INSTALL
Sewer Water Work. Tyke N'E~J
REMARKS:
FEE SUMMARY:
I3a~e Fee ~~i2.50
StarcJzarge ~ 51~
Tcatal Fee CC
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~:®RITRACT®R: - A~nI i~;ant - ®VVI~IER:
VALLEY F'L~~ GO ~'~iG fiQTTLtTND CO I Z~c:. ,
~i10 CREEK LA
30RDA~3 ~N 55352 ~CXX MN
t~r127 492-2121
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I HERE~tY AGREE THAT THE WORK F'r")R WHICH THIS FERN I T I S I SSLTFD SIIALL ~tE FER-
FOI<3~FD ACCORD I NG TO ; f 1) THE A FFROVED FLANS AND SPEC I F I CAT I ~.3NS ; ~ ~ ? THE
AF'FL I C;ABLE G I TY ORD I NANCFS ! A IUD Gt~DfiS ; ANI) , THE :~1~ STATE EtI I T1D I NG C.ODB .
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I SUED BY: SIGNATURE
SEWER AND WATER PERMIT APPLICATION
' CITY OF LAKEVILLE
BUILDING INSPECTION DEPARTMENT
20195 HOLYOKE AVENUE, P.O. BOX 957
LAKEVILLE, MINNESOTA 55044
(612) 469-4431
DATE• ~~11'~3
JOB SITE ADDRESS: O~~j,)aL3 Cc~~,ta~ C~ PID ~-r~C'
LEGAL DESCRIPTION: LOT: ~ BLOCK: ~ SUBDIVISION: " ~ ' ~ S~
APPLICANT: OWNER OR ONT ~ (circle one) ~ ~y C.~; "
OWNER OR BUILDER: ~i~ ~ w~~c~ PHONE:
STREET ADDRESS:~N CITY: ZIP:
CONTRACTOR : V 4~ , I ~ C ~ ~ CONTR . NO ~_PHONE
STREET ADYDRESS: CITY: ZIPS
FOR: RESIDENTIAL COMMERCIAL INDUSTRIAL PUBLIC
JOB COST: (FOR COMMERCI~ ONLY)
IS STREET EXCAVATION NECESSARY? YES NO
TYPE: FEE:
'~i"' x SEWER/WATER INSTALL (31)...... + .50
' ~
SEWER INSTALL (32)............ 29.50 + .50
WATER INSTALL (33)............ 29.50 + .50
PRIVATE SEWER (34)............ 74.50 + .50 (NEED TO PAY CTY FEE)
COUNTY SEWER FEE 29.00 COUNTY SEWER FEE
PRIVATE SEWER REPAIR (36)..... 74.50 + .50 (NEED TO PAY CTY FEE)
COUNTY SEWER FEE ...............29.00 COUNTY SEWER FEE
SEWER/WATER CONVERSION (37)... 49.50 + .50
SEWER CONVERSION (38)......... 29.50 + .50
WATER CONVERSION (39)......... 29.50 + .50
COMMERCIAL (40) 1$ OF CONTRACT COST UP TO $10,000
(INCLUDES WATER/FIRE LINE) AND 1/2~ OF COST ABOVE $10,000
PLUS SURCHARGE
(SURCHARGE = CONTRACT COST x .0005)
~ COMMERCIAL MINIMUM.....29.50 + .50
'I~
MISCELLANEOUS (45)............ 29.50. + .50 (MINIMUM)
(INSTALL MANHOLES, ETC.)
APPLICANT'S SIGNATIIRE: DATE:
SEWER AND WATER PERMIT APPLICATION PAGE 2
OFFICE USE
WORK E INSPECTIONS
NEW (81) ROUGH-IN (64)
ADDITION (82) INAL (65)
REPAIR (83) (70)
DEMOLISH (84j
REPLACE (8 5 )
ALTER/REMODEL (86)
MOVE (87)
PERMIT FEE: y
~<<-
PERMIT FEE: $
SURCHARGE : $ ~
OTHER: $
TOTAL: $
ti ,
i . C
APPROVED BY : ~ ~ ~ ~ DATE :