HomeMy WebLinkAboutNo 11410
_ a~t~^ ?r~~r~su d_y, -'"~-~ae- •.~Y ~Ytst£t , '~°+'-ek`~ #'.~d "~'r ;i>', ~ 'i- 9'. cP~, ,
City of Lakeville May 1, ~ s7
N~ ~ 1 ~ Q` INSPECTION DEPARTMENT
Permit Fee'.......... 39.50
SEWER AND WATER PERMIT su
AND R EC E 1 PT State Surcfwrge
TOTAL FEE PAfD . 40.00
Friedges Landscaping
Pwrmiasion is har~by grnntsd to
f3uildinq on Lot No. 5 81ock 1 Subdivision Dodd Pointe 3rd Addn
Pereel 22-20862-050-O1 Plat
in ttte CITY OF LAKEVILLE to be used as Permit , to connect to city sewer & water system
This permit is issued on the express condition that the -ERECTION ,ALTERATION REPAIRS
INSTALLMENT .-MOVING DEMOLITION respects to the stdtements certified to in the application for
such permit, aad that all work shall be done in accordance with the Ordinance of LAKEVILIE, Minnesota and the State
al! Minnesota pertaining to the construction of buildings.
Street.Address 16074 Excel Wav Gle n A Laneort~,
Direetor, Lic~ns~ and Inspettlon
Attanlbn is pertleulerly CaMled to the cutting up of streets, making main sewer connections, driveways and
cirba. Obtain permit Jor lUCh construction from the CITY OF LAKEVILLE Ispecton Department Not
ReaponSil~sForArryDsmegeatopublicUtiGhes. f r
By r ~ ( ~ ~1
The p6In1i1 holder understands end agrees that granting thls permit is not a warrardy or representation by i ~ J f it ,~r~
the City thffithe protect wIH be safe or satisfactory. n f' ~ ~ ~ , ~ F~ J 11
The permit Fake[ understands and agrees that the City shall have the nght to make periodic inspectbn ~i
during COrtBtrUCti01T. H Ute permit holder does not make arrangement to the inspection the City may tun / /
off the water untie 9uChinapectbn has been made.
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8747 208TH S~IREET WEST
P.O. BOX 9.57
~ LAKEVIL~E, MN 55044
469-4431
DATE:-_ S~~
.JOB SITE ACDRESS:_~,~~~ PID
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LEGAL DESCRIPTION: LOT: ~ BLOCK:T_~___ SUBDIVISION OR SECTION: ~j ~
APPLICANT: OWNER OR CONTRACTOR (circle one)
OWNER OR BUILDER: ~o~Z_~0.~ ~t1S'~"`- PHONE:
STREET ADDRESS:_ (o ~j -~.1-~~ ~,r~ CITY:~~~(~c,~,,~'~-- ZIP: ~~~'j(og`/`
CONTRACTOR: i c ~ CI T Y ID NO.: PHONE: ~ ~ C~~
STREET ADDRESS:~"?~~7 ~1~'r~~--V`-) CITY: ~5~-~.~.()~ ZIP: ~ ^C '
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FOR: ~ RESIDENTIAL COMMERCIAL INDUSTRIAL PUBLIC
IS STREET EXCAVATION NECESSARY? Yes No
TO INSTAL FtE
SEWER/WATER INSTALL (31; 39.50 + .5
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 CONVE SION (39) 19.50 + .50 `
~;t
APPLICANT SIGNATURE: ~ DATE:
'
OFFICE USE
4~ORK "fY~E 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: $ 9~,~'~
SURCHARGE: $ ~p
OTHER: $
I
~ TOTAL: $ _ ~U~ ~O
APPROVED BY: DATE;,~`~
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