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City of Lakeville J~~e zo, ~ ~5
I . N° ~ t~859
INSPECTION ~fPARTME~IT
` Perfrtit Fee
SEWER AND! WATER PERMIT - ~
AND RECEIPT state surt:hmge ~~50
roT~u. F~~ ~e. oo
Pttrmission is hereby grortt+d !a 4r-i
ed,~~ ae T.rs>,,•t ~ i!+~~ryj~,~ f Tai ~a i- a~ rh C:nst ®t r ~,a^ t i
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Buildin4 on Lot No. 14 81ock Subdivision Dodd POin~i~;, „
Psrcel '~22-2Q$6Q-140-01 Plat
irrtfte Cl1Y OF IAKEViLLE to t~ used as Piermit to connect to city water and aewet~,~s ,
'Phis pertttit is issuad ore the express condition that the ~,_ERECTION "..ALTERATION ___._REPAIRS
~IfdSTA1.LMEN7 `.MOVING ~_DEMOLITIONrespects to the statements certified to in the application for
wrh pileirmit, and that all work shall be done in accordance with the Ordinance of LAKEWILLE, Minnesota and fhe State
of Minnesota pertaining to tfie construction of buildings.
Sttroet Address Ib207 .x ~18j or Gt rcl a f;T a'nn A_ Tsln~or
.Attentlort iB.paeYOWer#ir edlad M Hta twttinpUp of atreeffi. making main sewer connections. driveways and Director, LIL~gtN and IQtd9~etli$ft .
CIfb6. C)bMit p®Inrk for t1UCh conabuction=han;the CITY OF LAKEVILLE Inspection DeD~ment Not
RespoeiNMB Fvr Arry Damepea to PubHC UUNties.
Tha parmgbOldar urMlr9flrMa enii agrees that granting this permit is not a warranty or representation by ~
Mc Cfb tftat tfte projscRwptbs safe or sathtactory B
Y `
The pematholder imdarstenda and agrees that 4he City shall have the right to make periodic inspection -
durir~..ion:pthepermd holder does not make arrangement for the inspection the City may tam
oR the wMM unWeurol~ InapecHon'tias been made.
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CITY OF LAKEVILLE '
,SEWER AND WATER PERMIT APPLICATION
Date (4 ~--1C3 ~o
Job Site Address ~ Lq ~ ~ ~ ~~"~.9d-~
~~10~-~
Legal: Lot Block Addition ~ ~ i
Owner or Builder ~ .
Excavating Contractor ~-~9,:~/J ~ r ~a~1}~,~"~'~ Tel
Address ~,~j~~~.~C~~-~',---- ~-E--LtiJ Citq ~~..e s~ ~1 U~4. Zip ~C}L{y
Private Sewer System ($39.50 + .50) $
Private Sewer Repair ($19.50 + .50) $
,City Sewer & Water Connections~(39.50 + .50). $
Inside Plumbing-Conversion (19.50 + .50)• $
Sewer Connection Only ($19.50 + .50). $
Water Connection Only ($19..50 + .50). - $
Meter--($60.00) &:Pressure Reducing Valve. $
* Metro SAC Charge S/W Connection Units $
TOTAL CHARGES $ LEQ__~
Is Street Excavation necessary? Yes
No
Signed
Make checks payable to: City of Lakeville
,
Send payment to: City of Lakeville Glenn A. .(Barney) Langord
Inspection Dept. Plumbing & Heating Inspect.
Box 957
~ Lakeville, MN 55044 Tel: (612) 469-4431
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