HomeMy WebLinkAboutNo 10780 a?.
City of Lakeville April 23, ~s6
N~ ~ C~7$d INSPECTION DEPARTMENT
Permit Fee.......... 39.50 I
SEWER AND-WATER PERMIT
AND RECEIPT state surchorge Aso
TOTAL FEE PAID,. 40.00
Pdnniafion is herby proofed TO Hiltner ~lurZbinQ/Jos Miller Constructi n
Building<on Lot No. 16 81ock 10 Subdivision Donn~Y's Vallev Park lath Add
Parcel ~k22-21177-160-10 Plat
inthBCITYOF LAKEVILLE to be used as ~armit to rnnnPrt n ni y wafiPr~nd aew~r cvatem
This permit is issued on the express condition that the -ERECTION -ALTERATION -.REPAIRS
INSTALLMENT a._MOVING .DEMOLITION respects to the statements certified to in the application for
sueh permit, and that. :all work. shall be done in accardancewith the Ordinance of LAKEVILLE, Minnesota and the Stste
of Minnesota pertaining to the construction of buildings.
i
Street Address 16325 Ftasia Avenue C:1 pnn A T.antcnrrt
Attention b perdCUlery Caged t0 ttM CuttMrQ tW of streets, making main sewer connections. driveways and DiretTOr, LicenYr? and InsptetlOn
cubs, f?b~ln penMt forsuitrtnnetructian from the CITY OF LAKEVILLE. Inspection Department Not
Respprleitile Far Airy Damages to Public U tiWties.
The permFt hOltler tuMaIBWWs and agrees that granting this permit is not a warrarrty or representation by ~
the ciH M~ dte project wiN be sate or satisfactory. BY L~.3d~'
The permit ttOWet understands and agrees that the City Shall have the right to make periodic inspectbn L~iaid~~
dwinp aort69Ylation. N the permtt holder does not make arrangement for the nspection the Gry may ttrn
oN the water tntA Such inepectbn has been made.
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CITY OF LAREVILLE
,SEWER AND WATER PERMIT APPLICATION
Date ~
Job Site Address ~ ~ e ~ ~d2<<.,..~-~
Legal: Lot Block Addition
Owner or Builder ~ --F'/ ` s~--~
> ~
Excavating Contrac r r/ ~ Tel.~~~"~ ~ ~
Address ~~r~~''-- ~ City. Cam, 1~~-..r,~ ZiP
Private Sewer System ($39.50 + .50) $
Private Sewer Repair ($19.50 + .50) $
City Sewer & Water Connections*(39.50 + .50). $ ~ U
Inside Plumbing Conversion (19.50 + .50)• $
Sewer Connection Only ($19.50 + .50). $
Water Connection Only ($19._50 + .50). - $
Meter-($60.00) &-Pressure Reducing Valye. $
* Metro SAC Charge S/W Connection-Units $
TOTAL CHARGES $
Is Street Excavation necessary? Yes
No
Signed ~ ~
Make checks payable to: City.:o~` 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