HomeMy WebLinkAboutNo 11446 '.~S.w.~h•'t"'~. czar 4.iv-{~+a'~dw t.>x^. 4_~q~rrs;~frJ,, : ~'F~
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City of Lakeville
rj° ~ ~ 446 INSPECTION DEPARTMENT
Permit Fee.......... 39.50
SEWER'AND WATER PERMIT
AND RECEIPT state s~rchurge so
TOTAL FEE PAID . 40.00
P~rnnission is t?ertby prantsd to Bohn Well Drilling
Pt~ o~f Sect. 17, -T114, R20 ~ o~
Building on,.Lot No. Block Subdivision
Parcel 22-01700-015-57 Plat
in the CITY OF LAKEVILLE to be used as permit to install private septic system. -
This permit is issued on the express condition that theFERECTION ,ALTERATION .,REPAIRS
X INSTALLMENT -.MOVING iDEMOLITION respects to the statements certified to in the application for
such permit, and that all work shall be done in accordance with fhe Ordinance of LAiCEVfLLE, Minnesota and the State
o! Minnesota ;pertaining to the construction of buildings.
Glenn A. Lani;ord
Street Address X8728 Dodd Blvd
Attention b P~f:UtB1N CeIIBd to the cutting up of sheets, making main sewer connections. driveways and DirlCtOr, Litfnft aed tnsOstNOn ' -
orbs: Oblekl permff ::tot euGh construction from the CITY Of LAKEVILLE. Inspection Department Not
' ReaponeY5le For Arty Dsmege8 to Public Utllities. f ^
.1 i i~
The permA ttOldel understands end agrees that granting this permit is not a warrarrty or representation by ~
theCify(tletthe(XOteCteeiNbesafeorsatisfaetory. By ~ tri~ ~~"~-'y / 'r;
The permR.hOldel Underetantls and agrees that the City shall have the right to make periodic inspectan
duringcatstruoNa+, tl the penntt holder does not make arrangement fa the vtspection the City may tum ~ ~ '
oif tha water iriNl such inspectbn has been made.
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SEWER AND WATER PERMIT APPLICATION
CITY OF LAKEVILLE
INSPECTION DEPARTMENT
8747 208TH STREET WEST
P.0, BOX 957
LAKEVILLE, MN 55044
469-4431
DATE: 2 7
JOB .SITE ADDRESS; ~v PID t~?1 J
LEGAL DESCRIPTION: LOT: BLOCK; SUBDIVISION OR SECTION;
APPLICANT: OWNER OR CONTRACTOR (circle one)
OWNER OR BUILDER: ~ PHONE: 8~~ - 22.c~2.-l
STREET ADDRESS:. CITY: ZIP:
CONTRACTOR:~I,n /,,,d~fj~ /.~~t~/h-~, CITY ID N0, : ~ PHONE:~G,~,f"~~
.STREET ADDRESS: /~S~S~ ~f ~ ~ CITY: ~~,/~~,T ec ZIP: ~ J~~ ~q
FOR.: RESIDENTIAL COMMERCIAL INDUSTRIAL PUBLIC
IS STREET EXCAVATION NECESSARY? Yes No
TO INSTALL: FEE:
SEWER/WATER INSTALL (31) 39.50 + .50
SEWER INSTALL (32) 19.50 + .50;
WATER INSTALL (33) 19.50 + .50
Pf~~TVATE SEWER (34) 39.50 + ,50
WELL (35) 39.50 .50
PRIVATE SEWER REPAIR (36) 19.50 + .50
SEWER/WATER CONVERSION (37) 39.50 + .50
SEWER CONVERSION (38) 19.50 + .50
WATER CONVERSION (39) 19,50 + .50
APPLICANT SIGNATURE:~~~_ _-Y~ i~~;,~-~.- DATE: ,~/,,Z-~~