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City o~~ Lakevihle ~ 1>> 84
N° ~ INSPECTION ~ _ 29.so
SEWER AND WATER PERMIT ' Permtt Fee...... ~
AND R E~ E I PT - - =-3tm"bmge ..L , , ' ' so
TOTAL FEE PA{D 3Q. 00
P•rmtssion is M.rsby pront•d to Larstrn Excavating / .Joseph M. Miller
Building on Lof iVo. 11 81ock 11~ Subdivision DOnit~l'8" ~a~-~~~ ~~x'k $t~'l Adtltl
t Psreel ;'t22-21177-110-11 Plat
I in the CITY Of LAKEVILLE to be used as Permit to connact to ci,tz~T a®yar and saaP_~r >s;ssf`as_a_:
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i This permit is issued on' the express condition that the _eRECTION ____.ALTERATION -REPAIRS
~X INSTALLMENT .-MOVING -DEMOLITION respects to the statements certified to in the application for
such pecritit, and that aH work shall be done in accordance with the Ordinance of LAKEVILLE, Minnesota and the State
c! Minnesota .pertaining fo the construction of buildings.
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Glenn A. Langord'
:Street Address tAht>e ~'®,,.z,~,tiaLa Avtan~se
Director, License and Inspection
Called tO the Witting up of streets, making main sewer connections. driveways and
Ciebs.ObteilpemNt for such cAnatruCtlon: from the CITY OF LAKEVILLE. Inspectbn Department tJot
geeponait>Ie For Arty Damages to PubNc UdAties.
The permit holder urtderetenda and egress that QrBnting this permit is not a warrarrty or representation by
the City that the protect wiN be safe or satisfactory. By
The permR hOWer Undarstends and agr6es that the City shall have the right to make periodic inspectbn
dwkp coneiructlon. H the pBrmN holder does. not make arrangement for the nspection the City may tum
oft the vratter Untiisuoh klapeCtbnhas beery made.
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CITY OF LAKEVILLE
.SEWER AND WATER PERMIT APPLICATION
Date 17 , 19 8 Q
1 E 218. £F.Iv'TAS IA
Job Site Address
11 11
Legal: Lot Block Addition
Owner or Builder JCE 1`-".ILLER CCNSTRUCTICN
Excavating Contractor LA.R~CN EkCA~ATING
Address 15FG4 CCRNELL TR.A,IL City RCSEPCUNT, R~IP_N Zip 550h8
Private Sewer System ($29.50 + .50) $
Private Sewer Repair ($14.50°~+ .50) $
Sewer & Water City Connections*(29.50 + .50). $ ~'f
Tnside Plumbing-Conversion (15.50 + .50)• $
Sewer Connection Only ($14.50 + .50). $
Water Connection Only ($14.50 + .50). - $
Meter .($60.00) & Pressure Reducing Valve. $
* Metro SAC Charge S/W Connection Units • $
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TOTAL CHARGES $ ~
Is Street Excavation necessary? Yes
No
Signed
Make checks payable to: City of Lakeville
Send payment to: City of Lakeville Glenn A. -(Barney) Langord
Inspection Dept. Plumbing & Heating Inspect.
Box M
Lakeville, MN 55044 Tel: (612) 469-4431