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HomeMy WebLinkAboutNo 11441 ..r: - .,tit;<~.. .3::~` _ ri ,.,ftb+. .:r:. ~.f,,'~i°"~" ` ~ .fir rT ~'~k t City of Lakeville May 12, ~ s~ ~ !N`'SP~E+CTION DEPARTMENT ~ ~ ~ ~ ~ ~ Permit Fee ~ 9. 5 0 $40.00 credit SEWER AND WATER ~ERMI• ~ so used: AND RECEIPT state surcharge..... TOTAL FEE- PAID . ' 40.00 Pemnission is herby gronfed to RC P lmb Q - Building on Lot No. 11 81ock 1 Subdivision Dodd Pointe 3rd Adtin Pereel #~22-20862-11C-C1 Plat in the CITY OF LAKEV1LLE to be used as permit to connect to city water and sewer svatem This permit is issued on the express condition that the -ERECTION ,ALTERATION REPAIRS -K INSTALLMENT .-MOVING _DEMOLITIONrespects to the statements certified to in the application for such permit, and that all work ahafl be done in accordance with the Ordinance of LAKEVILLE, Minnesota and the state of Minnesota pertaini~ to the construction of buildings. - .Street Address 16Q44 Excel lr'ay Pnn ~ _ T.angc,rrt Director, L,itense and Inspection At~tlon b pmtleuWy ceNed to the cuttingup of sheets, making main sewer connections driveways and eurbe. Obtekl pemtlt for suoh wnsduoitbn hom the CITY OF LAKEVILLE. Inspection Department Not Reeponaitile For Arty DameOes to PubNC Unities. The permk holder und8r8tMda end agrees That granting this permit is not a warranty or representation by the City tt,u the project v?iN be sate or seY~atectorY B y iv~N..J The pefRtit fwWer Underetends and agrees that the City shall have the right to make periodic inspection dta'kp cotrotructian...H IhepermR..lwkferdoes not make arrangement for the inspection the City may tum off the water unlNSUCh inspeotion has been made. -d1~ _ _ I „'I _ ~ , A N,~ ~ i~r.u Y ~ ~ ~ IG^~ ~ I"~ ~ ~ ~ ~ 3 SEWER AND WATER PERMIT APPLICATION CITY OF LAKEVILLE INSPECTION DEPARTMENT 8747 208TH STREET WEST P.0. 80X 957 LAKEVILLE, MN 55044 469-4431 DATE: I / JOB SITE ADDRESS: PID LEGAL DESCRIPTION: LOT: f/~ BLOCK: ~ SUBDIVISION OR SECTION: ~ h 3~ APPLICANT: OWNER OR CONTRACTOR (circle one) OWNER OR BUILDER: ~ Q,~,,.a,~ti~~~ PHONE: ~ a - STREET. ADDRESS: CITY: ZIP: J,5 1a~ CONTRACTOR: CITY ID NO.:[~_ PHONE: `~~o~ a ~ ~~P STREET ADDRESS: ~ CITY: 1~~~~ ZIP:~'~O~? FOR: ~ RESIDENTIAL COMMERCIAL INDUSTRIAL PUBLIC IS STREET EXCAUATION NECESSARY? Yes No TO INSTALL: fEE: O SEWER/WATER INSTALL (31) 39.50 + .50 SEWER INSTALL (32) 19.50 + .50 WATER INSTALL (33) 19.50 + .50 PRIVATE 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 it APPLICANT SIGNATURE: DATE: f / JtWtK HNU WH I tK t'tKl~ll I F'Hbt L OFFICE USE WORK TYPE INSPECTIONS NEW (81) ROUGH-IN (64) ADDITION (82) FINAL (65) REPAIR (83) (70) DEMOLISH (84) REPLACE (85) ALTER/REMODEL (86) MOVE (87) PERMIT FEE: PERMIT FEE: $ ~ / ~ ~~C7 SURCHARGE: $ c.~ ~ OTHER: $ TOTAL: $ r© ~ APPROVED BY: DATE: ~j