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No 11263
~n. ~ - . r- k , r ~ i~. , °k , ?r ,'F„ c :dt'4" ' 'v 'i~'r- r-n~, b City Qf Lakeville Jan 21' N~ 1 1263 INSPECTION DEPARTMENT 39.50 'SEWER AND WATER PERMIT Permit Fee.......... ANp'RECEIPT stotesureharge..... so TOTAL FEE PAID . Permission is herby ywrttsd to T.,c3.~C@ Sine Se~*er ~A. ~~a~er/T,r1~.C~1ael ,~d~ ell Constr . Building on Lot. No. 1-~ 131ock Subdivision p~1-iite 3rd AddltloIl Parcel 22-2062-14Q-;j~?~. Plat in: the CITY OF LAKEVILLE to be used as perrrst to connect to city sewer ~x taatez' system fihis pet*mit is issued on 4he express condition that the ---.ERECTION -ALTERATION ~REPAtRS ~X INSTALLMENT -.,-.MOVING .,_DEMOL.ITiON respects to the taternerits certified to in fhe application for such permit, and that all work shall be done' in accordance with the Ordinance of LAKEVILLE, Minnesota and the Stsh of Minnesota pertaining to the eonaruction of buildings. Street Address 16030 ExC~I inlay C;lerm A, Lan~;ord Attention a partlcularly Called to: the cutting up Cf streeis, m~cmg mainsewer connections, driveways and Diratror, LiS~I1ril. and 9nspetflon curbs. Obtain permftfpr such. construction. from the ClTV pF LAKE~tII.E Inspectpn Department Not Responsible For Arty Damages to Pubfic Utikbes. fie pertnR holder Wrderstands and agrees that granting this permit ~s no! a warranty or representation by I~ the City that Me protect wa be safe or saGSfectory. By Thepermit FtokJer understands and agrees that the City shall have the right to make periodic inspectbn - " during conaMuction.lf ihe-permit twMer does not make arrangement for the-inspecbonthe.Citymay tum' off the wale' untA such lnbpectbn has been made. i 1 i ~vW 1~ ~ 3 ~ ~ ~ 7 DATE ~ ~ b f CITY OF LAKEVILLE APPLICATION FOR SEWER AND WATER PERMIT Site Address : O3 t~ ~..~L ~ / ~ 6~(JZ Legal : Lot Block. Addition a r o ~ G'© _ v~ Owner o r B uilder : ~ i /C ~G~C. Phone : - ~i''•~/8 Address: ~1/7~ 7i4srn,nc City: ~d~~' ~ro~c ZiP~ C Excavating Contractor: _ a-.~ S% Ste, ~ (,.~,A-7~'rr-Phone: ~`J~y C,~b Address: /.,,2L/.~ ~f ~,-~r-,4,,,, f~v'~ City:~rrv.9-~ L Zips ,~"5,3.7~ Private Sewer System ($39.50 + .50). $ Private Sewer Repair ($19.50 + .50). $ City Sewer & Water Connection ($39.50 + .50). $ Inside Plumbing Conversion ($19.50 + .50). $ Sewer Connection Only ($19.50 + .50). 02 b• O ~ Water Connection Only ($19.50 + .50). 0~ 0~ b Meter (3/4 in) - ($60.00}. $ Pressure Reducing Valve ($42.75). Metro SAC Charge. . $ Sewer & Water Connection Units. Total Charges ~d °d ~ Is Street Excavation necessary? Yes I No~ MARE C HECKS PAYABLE AND SEND PAYMENT T0: CITY OF LAKEVILLE Inspection Department P.0. Box 957 Lakeville, Minnesota 55044 Glenn A. (Barney) Langord Call 469-4431 to schedule inspections. Plumbing & Heating Inspector