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No 10866
~ _ ~ ~ ~ ~ >wr .W ,ow~'a ,.;ya,~n+4~~.',~~- 1Fi^i..,,+~, w, [o a ~~4;w,.='.~-. ~ ~s,;~ j f City Lal~evJle .~un~ 13• ig86 ~ moo' ~ INSPECTfQN DEPARTMENT SEWER AND VI/ATER PERMIT Permit Fee.......... 39.50 AND RECEIPT StateSurcfrarge....:' •~o -TOTAL F6E PAID,..:. 40 • Jeche Exca.vat~ns/Wagner Hompa fir Permission is heroby yrantid to ~ r Buiidiny on Lot No. 10 Block Subdivision Dodd P n e ~ Paceel ~#22-2©860-100-01 Plat in the CITY OF LAKEVILLE to be used as ~~rmit to connect t4 et to water sort a~~rer ~vtilt+l~t I Thi3 permit is issued on tfie express condition that the ~Ei2ECT10N ..~ALTERATtBN l...REPAfRS INSTALLMENT ,.-.MOVING ~DEMOLITIONrespects to the statements certified to in the application for ,such permit, ahd filet ail work shalt`be done in accordance with fhe Ordinance of LAKEVILLE, Minnesota and;-the State of Minnesota pertainihy to the construction of buildings. Street Address 161b~ Excelsior Dftve f'1 ~ - yp>a~ard AitsxttlEMe bpartlOUlard/CaNSd t01ha cUttlnp upol streets, making main sewer connections, dnveways and Dlrsetor, Li+:~ns! and Inspaetlon f cubs. tJb1eY1 permit for such. cpnsiniCt7on from the CITY OF IAKEVILLE. Inspection Department Not ReepOnetbls FW Arg+ Demapes to Pubsc tlueties. !i The pBnnl! hOWer ugdefbiSrJda end sprees that granting this permR is not a warranty or representation by fha try t~ flea pokot wa ba safe w iseNstactory. B y The permit holder uridsrstends and agrees that the City shag have the right to make periodic inspection. - ~ during oarotructiorf. H the permit holder does not make arrangement for the inspection the City may cum Off fhe wstlr UMS such (re9pec!!on has been made. -T ~ T _ ~ ~ ~ r. , ~ Y _ / - V ~ / ~ l ~ S~~A ~ ~ CITY OF LAREVILLE ,SEWER AND WATER PERMIT APPLICATION Date ~ p~ / _ Job Site Address ! ~ X ` ~~p j„ Legal: Lot Block Addition Owner or Builder ~ Excavating Contractor ~ ~ ~ ~ Tel. J ~ ~S Address C City 1,~~ ~ Zip 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). - $ n7 Q, Q Meter--($60.00) Pressure Reducing Valve. • $ * Metro SAC Charge S/W Connection Units $ TOTAL CHARGES $ ~ Is Street Excavation necessary? Yes No ' rj~' _ 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