HomeMy WebLinkAboutNo 11431 ;n - ~ Aw,
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City of Lakeville May ~ s7
1 ~ ~ ~ 1 INSPECTION DEPARTMENT 39.50
SEWER AND WATER PERMIT Permit Fee..........
State Surdwrge .50
AND RECEIPT
TOTAL fEE'PAlD . 40.00
Plymo~ith Plmbg Inc
Permission is hetr~t>y grontsd io
5 12 Donnay's Valley Park 8th
SttNdinQ;on Lot No. Stock Subdivision
Payee! 22-21177-050-12 Plat
in the CITY OF LAKEVILLE to be used as Permit to connect to city sewer & water system
This permit is 3sued on the express condition that the _[RECTION -ALTERATION .-REPAIRS
,.-X INSTALLMENT MOVING _QEMOLITIONrespecis to the statements certified to in the application for
such permit, and that all work shall be done in accordance with the Ordinance of LAKEVILLE, Minnesota and the State
a! Minnesota pterfaininy 1o the construction of buildings.
R2gXXK~~~{,Z#I$~X 16090 Fairgreen Ave Glenn A. Langord
'Street Address-
Attention b perdcularN called to the cutting up of streets, making main sewer connections. driveways and DirletOr, Lit~ns~ and tnspK}lon
CIX68. cbtaln 'p9rmlt for Such constructbn from the CITY OF LAKEVILLE. Inspection Department tJOt
ReBpOn>sibb For Arty Damages to Public UtiMUes. , ~
The pemdthotder understands and agrees that granting this permit is not a warranty or representation by
are city that the a~ wIA be safe or satisfactory- B ~ ~ ~ ~ ~ ~ ~ ~ _ ~ ~
Y „ .-1'
Thepamift poker understands and agrees that the City shall have the right to make periodic inspection / /
Curlnp ealBtruction. H the permit holder does not make arangement to the inspection the City may cum / ~
off the water until such inspecton has been made.
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SEWER AND WATER PERMIT APPLICATION
CITY OF LAKEVILLE
INSPECTION DEPARTMENT
8747 208TH STREET WEST
I P,O. SOX 957
LAKEVILLE MN 55044
469-4431
DATE: S- ~7
JOB SITE ADDRESS: /1~0g0 ~,4,-„Yh,«,,..~ PID
LEGAL DESCRIPTION: LOT: BLOCK, SUBDIVISION OR SECTION:
.APPLICANT: OWNER OR CONTRACTOR (circle one)
OWNER OR BUILDER: ~oe.- `1'Ir!/-~~- ~al~-S f' PHONEt 8~1~- 1DlD
STREET ADDRESS: ~S'/ ,?~-,3 ~~Ry~~v-c CITY: /-~s2~~,?tis~ ZIP:
CONTRACTOR: J~ ~y vnou.o~-~, /~lg ~"ti~ CITY ID NO.: lrJaol~,s~ PHONE: ~.5"`St--3C~7J~
STREET ADDR.E-~S-S: 1~{-~-a8 ;~-3n~D•~J~u. CITY:~~ ZIP:
FOR: ~ RESIDENTIAL COMMERCIAL INDUSTRIAL PUBLIC
IS STREET EXCAVATION NECESSARY? Yes No v''~
TO INSTAL~L; - FEE:
t/ 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: wreircY~X ~dt~.J DATE: ~T -s Pi "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: $ ~ 9 w~Q
SURCHARGE: $ ~ ,.~0
OTHER: $
TOTAL: $ Q
APPROVED BY: DATE: ~