HomeMy WebLinkAboutNo 10976 .m~cr,~-r.~,..--.war .v.,r.....c
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City of Lakeville AuQUSt 12 • ~ a6
10976 INSPECTION DEPARTMENT
Ptetrmit Fee ; 39.5 0
SEWER AND WATER PERMIT so
...AND RE~EI P'T state stw~ch~ge
TOTAL fEE PAID . 40.00
Petmhission is h®nby grontad to Lakeside Sewer & Water/RSM Homes
t3uilding on Lot No. ~ Stock Subdivision Dodd Pointe 2nd Addition
Psreet 22-20861.-X070-02 Plat
in tht3 CITY OF LAKEVILLE to be used as perm r to connect to cj„~~ a w r & wa er a~gtEam
This permit is issued on the express condition that the .~ERECTtON _ALfiERAT10N REPAIRS
i INSTALLMENT .-MOVING -DEMOLITION respects; to the statements certified to in the,'spplitatioa ,for
such permit, and-that a#I work shall be done in accordance with the Ordinance of LAKEVttLE, Minnesota and`the State
o[ Minnesota pt!?tainin9 to the construction of buildings.
16249 excelsior Drive Glenn A.`LanQord
Street Address
Attention B ptrtiCUlarty Called to Me cutting up of sheets. making main sewer connections, driveways and DiretiOr, lierans~. •nd Inapvetion
~ Curbs. ObtaM permit for such conshuclion from the CITY OF LAKEVILLE Inspectwn Department Not
Reepons~lafor My Darneges to PubNC Utilities.
' She permit holder understands and agrees that granting this perms is not a warranty or representation by
ine Gty etae the proiact wlq be sete'or satist~torv. By ~ Q.
The pmrNt ttoider underetandeand agrees that the City shall have~the right to make periodic mspectbn
~0 tiof~truC;ion. H the permit holder does not make arrangement for the mspactien the Ciry may hxn-
~ otttM Watts until such InapaChOn ties been made.
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CITY OF LAREVILLE
. ~ ,SEWER AND WATER PERMIT APPLICATION
Date / •
Job Site Address ~ 17`~ ~xcC t~ % L~
Legal: Lot Block Addition
Owner or Builder ,fC .,5~, /Y? ~z~rr, P I' ~ ,
Excavating Contractor ~i4-,~~ S-;~{ s L~~-~~- Tel. ~1
`,L 7~ a ~
Address j~ y ~ ~ Z;,~ r-~, ~~F City Ss}-~ Zip ..$"S.~ ~7~
Private Sewer System ($39.50 + .50) $
Private Sewer Repair ($19.50 + .50) $
City Sewer &-Water Connections*(39.50 + .50). $
Inside Plumbing~Coaversion (19.50 + .SO)• $
Sewer Connection Only ($19.50 + .50) . $ ~ . G? z:
Water Connection Only ($19..50 + .50). - $ C ~'t?
Meter--($b0.00) &-Pressure Reducing Value. $
* Metro SAC Charge S/W Connection Units $
TOTAL CHARGES $ ~C~. d ~
Is Street Excavation necessary? Yes ,
No JC
Signed r``~"~--~~~
Make checks payable to: City of Lakeville
Send payment to: City of Lakeville •Glenn A. .(Barney) Langord
Inspection Dept. Plumbing & Heating Inspect
• Bog .957
Lakeville, MN 55044 Tel: (612) 469-4431