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City. of Lakeville ~ i' ~ i ~ f
INSPECTION DEPARTMENT
Permit Fee.... 39.50
SEWER AND-WATER PERMIT
AND RECEIPT ~ st°te suret+orge
' TOTAL FEE PAID . 40 ~ 00
P~mtHsisn is herby yrentsd to W@nzel k4@Charilcal/R~ T ~+Groi ~ Bit{ 1 d~ria
Butldinq en Lot No. 12 81o<k Subdivis+on ~nr1A Pninta ?rid ~ri_rt~tinn
Parcel X22-20861-120-01 Plat
in the CITY OF LAKEVILLE to be used as ipermit to c4nnec.t to citg water and sewer s4t$tem
Ttti# permit i# #sued on the express condition that the _EItECT10N ~ALTERATtON ____REPAIRS
...._$INSTALLMENTMOVING ^DEMOLITiONrespects to the statements esrtitied to in the application for
' sUCh permit, and lttat atl work shall be done in accordancewlth the Ordinance of LAKEVILLE, Minnesota and the State
of Minnesota pertaining to the construction of buildings.
Sttroet Address 16234 Excelsior Drive Glenn A Lanaord
AttenhOn b perpculerty caXed to the cutting up of streets. makinfl main sewer connections. driveways and Dlrletgr, Liunst and (n1ttNCtt011
curbs. Obtaln pemtlt to such eonstructbn hom the CITY OF LAKEVILLE. Inspection pepertment Not
i Reaponalble FOr Arty Oamspea to PubNC U tlYties.
The permit holder underetends and agrees that granting this permit is not a warranty or representation by
j , the City that the project wtw be safe or saUafactory. _ B
The permit holler understands end agrees that the City shah have the right to make periodic inspection y
i durMq construction. h the penntt holder does not make arrangement for the inspection the City may tum
kI cif the water until such ktepectfon has been made.
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CITY OF LAKEVILLE
,SEWER AND WATER PERMIT APPLICATION
Date ii jaj~iLti
Job Site Address ' _ _ _ _
Legal: Lot Block Addition
Owner or Builder LaCroix Builders, ~ Denny Gelhar
Excavating Contractor '~'zr' Tel.
Address 3SL ~ ':.;af~~ ~ : ~ t~dt~N. 55.922 Zip
Private Sewer System ($39.5.0 + •50) $
Private Sewer Repair ($I9.50 + .SO) $
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 ValYe. $
* Metro SAC Charge S/W Gonnection Units $
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TOTAL CHARGES $ f
Is Street Excavation necessarq? Yes
No
Signed ~ ~ ,
Make checks payable to: City of Lakeville
Send payment to: City of Lakeville Glenn A. .(Barney) Langord
Tnspection Dept. Plumbing & Heating Inspect.
Box 957
Lakeville, MN 55044 Tel: (612) 469-4431