HomeMy WebLinkAboutLA032049 PERMIT
CITIF OF LAKEVILLE PERMIT TYPE: ~
X0195 HOLYOKE AVE. Permit Number: "~?~~;~1~~
Lakeville, Minnesota 55044 Date Issued: c
(612) 985-4440 ~ ~ 3, r
SITE ADDRESS:. F l?~ n~+~TC±~+}~ T T T T
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DESCRIPTION: ~i'
~ew~r W~tpz~ P*=rz~~.t Types WA,T~R ~~ISTAI.,T.~
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REMARKS:
FEE SUMMARY:
F¢~ ~ ~ 5th
S~.rc~iar~~ ~ ,~~0
To1;~.7. Fpe ~ X30 , f~fJ
CONTRACTOR:. - A~~l a.razzt - OWNER:
~iALLRFY PT.~MI~ C~ ~i~~ I~CITTT,,I.3~I~ C;;.3 I NC
'i t3~t~ t~i3AKER A.VIr ~:X~`
~~i1~) 4~?-~7.?1
I HFFiFFiY At:nF.F THAT THE ~~iHN F'C3Ii GIH I C;II THIS IjF:F~ ~ T I S 3 ~
;R `+JFI) ~ I?AI~I_, TiF F'F:R-
F€";H~EI? AC:C;CIFiT) I NAT T~1: { y THE A F`F'RnVET1 F1,ANS ANTS SF'Et"r; F I i;,AT T tlI'1c ; THF:
~ AFFI.IC,ARIrF CITY QHI}INANCF.^, ANT) C~#T?FS; ANT), (iii THE ~N S TATF' Ft1II,T}I.NG CC~IT)F.
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ISSUE BY: SIGNATURE
SEWER AND WATER PERMIT APPLICATION
CITY OF LAKEVII.LE
BUII.DING INSPECTION DEPARTMENT
20195 HOLYOKE AVENUE
LAI~EVII,LE, bBNNESOTA 55044 ,h
(612) 985-4440 ~
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DATE: i d I G; r~
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70B SITE ADDRESS: C, r t p i i~(.' ~ ~ PID
APPLICANT: OWNER OR CONTRACTOR (circle one)
OWNER OR BUILDER ~ ~ t ~ t _ ~ PHONE:
STREET ADDRESS: CITY: ZIP:
CONTRACTOR: t 1 z . i ~ ~ ~ ~ C CONTR.#:_ f PHONE:...
STREET ADDRESS: CITY: ZIP:
FOR: RESIDENTIAL ~ CONIlv1ERCIAL INDUSTRIAL PUBLIC
70B COST: (For Commercial Only)' ~~e,i
IS STREET EXCAVATION NECESSARY? YES NO -:,z~
TYPE FEE• ~ ~ i, ~(~;~~~~~,-r'a ~
SEWERNVATER INSTALL (31) 62.50. + .50 ~ ~~m,J
SEWER INSTALL (32) 29.50 + .50 ,
~ WATER INSTALL (33) 29.50 + .5
PRIVATE SEWER (34) 74.50 + .50 (Need to Pay County Fee)
COUNTY SEWER FEE 40.00 COUNTY SEWER"FEE
PRIVATE SEWER REPAIR (36) 74.50 + .50 (Need to Pay County Fee)
COUNTY SEWER FEE 40.00 COUNTY SEWER FEE
SEWERNVAT'ER CONVERSION (37) 49.50 + .50
SEWER CONVERSION (38) 29.50 + .50
WATER CONVERSION (39) 29.50 + .50
COMII~RCIAL (40) 1% OF CONTRACT COST PLUS SURCHARGE
(INCLUDES WATER/FIRE LINE) (SURCHARGE =CONTRACT COST X .0005}
CON1I~~RCIAL 11~IQVIlVIUM 29.50 + .50
MISCELLANEOUS (45) 29.50 + .50
(INSTALL 1~~IANHOLES, ETC.)
APPLICANT'S SIGNATURE: ~ RATE: C,~ 4
~ Revised 12/1/94
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SEWER AND WATER PERMIT APPLICATION PAGE 2
~I , OFFICE USE
WORK TYPE: INSPECTIONS:
W (81) ROUGH-IN (64)
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ADDITION (82) FINAL (65)
REPAIR (83) ~...._._..s_. (70)
DEMOLISH (84)
REPLACE (85)
ALTER/REMODEL (86)
MOVE (87)
PERMIT FEE:
PERMIT FEE: $
SURCHARGE: $
OTHER: $
TOTAL: $
APPROVED BY: ~ DATE: ~ ~ S
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