HomeMy WebLinkAboutNo 11433 - . _
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City of Lakeville May 7, ~ s7
"N~ ~ ~ ~3~ -INSPECTION DEPARTMENT 39.so
S-EWER AND WATER PERMIT Permit Fee.....
AND RECEIPT StoteSurcharge..... .SO
40..00
TOTAL FEE PAIQ .
Pennisaion is herdby >awntsd to Plymouth P1mbQ Iris -
2 12 Donnay's Valley Park 8th
Buitdinq_on Lot.. No. Block Subdivision
Psreel 22-21177-020-12 Plat
in the CITY OF LAKEVfLLE to be used as permit to. connect to city sewer & water system
This permit is issued on the express condition that the -ERECTION -ALTERATION ,REPAIRS
X
~ _ INSTALLMENTMOVINGDEMOLITION respects to the statements certified to in the application for
strth permit, and that all work shat! be done in accordance with the O.~dinance of LAKEVILLE, Minnesota and the State
ts# Minnesota pertaining to the eonstruction of buildings.
`Street Address _ T6036 Fargreen Ave Glenn A. LanQOrd
Attentlon'b pertlCUlartj Cilbd to the Cutting uD of sheets, making main sewer connections drweways and DireCtOr, litMSe and Inspeefioe
CufbS. Obtehl `permlt,toP twehCOnstructton from the CITY OF LAKEVILLE. Inspectbn Department Not
ReaponeM>fe ForAny Damages to Public UUGaes. ,
~ /
The permH holder understands and agrees that granting this permit is not a warranty or representation by ~ - q`
the City tti~ the Proieot wiNbe sate or satisfactory. BY,(L(,~~ / '
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The permit holder underatends end agrees that the City shall have the right to make periodic inspection
during conBMUCtIOn.[M tdepetmit holder does not make arangement to the inspection the City may tum
off the water until auchirtepeotibn has been made.
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SEWER AND WATER PERMIT APPLICATION
CITY OF LAKEVILLE
INSPECTION DEPARTMENT
8747 208TH STREET WEST
P.0. BOX 957
LAKEVILLE, MN 55044
469-4431
DATE: 5=v`~?
JOB SITE ADDRESS: ~f~a 3(p ~r.~e'r~NeeaJ PID
LEGAL DESCRIPTION: LOT: BLOCK; SUBDIVISION OR SECTION:
APPLICANT: OWNER OR CONTRACTOR (circle one)
OWNER OR BUILDER: Sot LITh ~-or-s7~; PHONE: ~oZ- ~Q/~
STREET ADDRESS: /~`l33 L°t~D~r.14vt CITY: ~~Iyh~lrc ~e„? ZIP:
r--7
CONTRACTOR: f~l7t ~tm~~!2~ IS ~,cJ~, CITY ID NO.: /~iot,6C~S" PHONE: 5~51`Z-3~7~
STREET ADDRESS: / 3RD CITY: ~l ynow~, ZIP:
FOR: t/ KESIDENTIAL COMMERCIAL INDUSTRIAL PUBLIC
IS STREET EXCAVATION NECESSARY? Yes No
TO INSTALL: FEE:
SEWER/WATER INSTALL (31) 39.50 + .50
SEWER INSTALL (32) 19.50 + .50
WATER INSTALL (33) 19.50 + .50
PRIVATE SEWER (34) 39.50 + .50
~ WELL (35) 39.50 + .50
PRIVATE SEWER REPAIR (36) 19.50 + .50
SEWER/WATER CONVERSION (37) 39.50 + .50
SEWER CONVERSION (38) 19.50 + .50
WATER CONVERSION (39) 19.50 + .50
APPLICANT SIGNATURE: L.J.~--'`~~.P~~~ DATE: ~s' r- ~'7
SEWER AND WATER PERMIT PAGE 2
OFFICE USE
WORK TYPE INSPECTIONS
NEW (81) ROUGH-IN (64)
ADDITION (82) FINAL (65)
REPAIR (83) (70)
DEMOLISH (84) -
REPLACE (85)
ALTER/REMODEL (86)
MOVE (87}
PERMIT FEE•
PERMIT FEE: $ ~
SURCHARGE: $ a_'~(~
OTHER: $
TOTAL: $ (1 r aQ
APPROVED BY: DATE: 1~^'4