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City of Lakeville Marsh ~s, mss
~Q ~ a~70 II~JSP~CTION DEPARTMENT
Penait Fee ~ - S O
SEWER AND'WATER PERMIT
AND I~ECEI PT State Surcharge ' .SO
TOTAL FEE'PAID : ~OOfl
P lymouth Plumbing, Inc. / Joe Miller Conet:.
Permission is heralay gronttd to
Buiidin~ on Lot No. 1 81ock 21 subdivision DonnayB Valley Perk BCh.Addn
' Psreai i~Z2-21177-010-21 Plai
in't;he CITY OF LAKEVILLE to be used as Permit to connect toc ct>l:y sewer and Wa1~er
This permit is is3ued on the express condition that the -ERECTION ,ALTERATION .._REPAtRS
INSTALLMENT ^MOVING -DEMOLITION respech 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
of Minnesota pertaining to the construction of buildings.
Street Address 16209 Fernando Way Glenn A. Langord
AttenNan b partletAartycaNad to the cutting up of streets. making main sewer connections. dtrveways and Dir~ttOr, LitMSe and Int:acHon
CUlba. ObtBil permRfor such. conahuction from the CITY OF LAKEVILLE, Inspectbn Department Not
`Resiw~taiae ForAtry Ddneges toPubdc Utilities.
Th9 pemdt hOldar understatWs and agrees that granting this permit is not a warranty or representation by ~ -~7
A theCity?tretttt6p?pJectw4lbesafeorsatistactory. g ! -
Th6 permit hOkJ6r understenda.and agrees that the Cify Shall have the right to make periodic inspecton
f dexinq CGOatruCliOn: Hffieparmit holder does not make arrangement for the inspection the City may tum
aH the water untr7 such fnapactton tea been made.
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CITY OF LAKEVILLE
SEWER AND WATER PERMIT APPLICATION
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Date /~H~~ `f v~ ~ ~J
Job Site Address _ ~(o.Z p ~ `Gs~,~J~~-~
Legal: Lot Block Add,~i~/tio//n ~
Owner or Builder ~0~-- ,r`i ``e~'~" ~US`t";
Excavating Contractor 0 ; tJ Te1.~59 -,3G T.S~
Address ~3 City ~~Jls, Zip
Private Sewer System ($29.50 + .50) $
Private Sewer Repair ($14.50 + .50) $
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City Sewer & Water Connections*(29.50 + .50). $ 3 8
Inside Plumbing Conversion (15.50 + .50)• $
Sewer Connection Only ($14.50 + .SO). $
Water Connection Only ($14.50 + .50). - $
Meter ($b0.00) & Pressure Reducing Valve. $
* Metro SAC Charge S/W Connection Units $
TOTAL CHARGES $ ~j ~
Is Street Excavation necessary? Yes
No
Signed 1,t~,~,~t.~ ~dz.t~,~?
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