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City Of Lakeville
~ 'I INSPECTICIN DEPARTMENT 39.50
Permit Fee..........
_ SEWER AND WATER PERMIT .so
AND RECEIPT State Surcharge .
4o.oa
TOTAL FEE PAID
Prmission is htraby grontsd to R. C, Plumbing/Sons Construction
Building on Lot No. 1~ 81ock 1 Subdivision Dodd: Pointe
Psreel 22-20860.-170-01 Plat
in the CITY OF tAKEVICLE to bt3 used as permit to connect to city sewer & water ~yst~ifl..,_
This permit is issued on the express condition that the ,Ef2ECTION ALTERATION ~...REPAtRS
INSTALLMENT ._Mf3vING .DEMOLITION respects to the statements certified to in the application for
~ such permit, and that all work shall be-.done in accordance with the Ordinance of LAKEVILLE, Minnesota and the 5taM
'of Minnesota pertaining to the construction of buildings.
1629 Excelsior Circle Glenn A. Langord
Street Address'
AttBfltt011 b partleulary.. Calbd totM CWtkp up of Streets, tnekinfl main sewer connections. driveways and DtfettOr, Lfiense ind InspeCNOn
cltrb8."ObleN permit for Duch cgtetructlott from theCITY OF LAKEVILLE. Inspection Department Not
fleeponD~eForArry ODenetgea to P~Ifc UOltties:
The pelmlt ftolder 1J end agrees that granting this permit is not a warrardy or representation by ~ J7
the GtY that pte project w111be Oafs or satisfactory. BY Y`
The pemdt holder understertds and Ogress that the City shall have the right to make periodic inspection
dtminp tbtMtruCNoft. H'-the permit holderdoes not make arrangement for the inspection the Gty may tum
off the. watl? until such hfapecfbnhas been made.
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DATE
CITY OF LAKEVILLE
APPLICATION FOR SEWER AND WATER PERMIT
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Site Address:
Legal: Lot Block Addition
Owner o r B uilder : Phone : 7~p~ ~ ~ o'j~
Address: City: Zip:
Excavating Con actor: ~ Phone•
Address : - City: ~ Zip: ,~,s~~f`
Private Sewer System ($39.50 + .50). $
Private Sewer Repair ($19..50 + .50). $
City Sewer & Water Connection ($39.50 + .50). $ C> ~
Inside Plumbing Conversion ($19.50 + .50). $
Sewer Connection Only ($19.50 + .50).
Water Connection Only ($19.50 + .50).
Meter (3/4 in) - ($60.00). $
Pressure Reducing Valve ($42.75).
Metro SAC Charge. . $
Sewer & Water Connection Units.
i Total Charges ~c~~
Is Street Excavation necessary? Yes
No_~~_
.MAKE C NECKS PAYABLE AND SEND PAYMENT T0: CITY OF LAKEVILLE
Inspection Department
P.O. Box 957
Lakeville, Minnesota 55044
Glenn A. (Barney) Langord Ca11 469-4431 to schedule inspections.
Plumbing & Heating Inspector