HomeMy WebLinkAboutNo 10495
~ ~ , -p k . ~..y~, y s s ~ 'x~=-~, , sR•. _ :-~:4~. ~ i ra'f't-"7
f ' - ~
City`~.f ~.~ke~vle~_ Ayril 22, ~ R5
~
f .
N~' ~ ~4~5 INSPECTION DEPARTMENT ~ 29.so
SEWER AND WATER PERMIT Permit Fee"""""
AND RECEIPT state surcharge so
TOTAL FEte'PAiD 30. ?t?
P.rmisaion is h.riby prentedto Plymouth Plumbing, Inc. / Joe Miller Const.
9 11 Donnay's Vallee Park, 8th Addn
$uildinq on Lot No. Block Subdivision
Parcel X22-2.1177-090-11 Plat '
in the CITY OF L.AKEVIELE to be used as Permit to connect to city sewer- and water.. spstem
lhix permit is issued on the express condition that the ERECTION -ALTERATION ,.-.REPAIRS
tNSTALLMENT -..-MOVING __,_DEMOLITION respects to thesVatements certified to in the application for
such permit, and that alt worlcshall be done in accardancewith the Ordinance of LAKEVILLE, Minnesota and the State
of MinAetwta pertaining to the Construction of buildings.
Street Address 163b2 Fantasia Avenue Glen? A. Langord
Attention b partfeufary Calved fo the cutNnp uppf streets, making main sewer connections. dr+veways and Director, LitMSe and InspeCfion
Cuba. Obta61 pemtitfor.6UCf1 constructiontrom tl5e CITY OF LAKEVILLE Inspectwn Department Not -
peeponable ForAny Dmnapas to Public UdMties.
lire permitholder urtderatarWa end sprees that granting this permi! is not a warranty or representation by n
the Citythat the project be safe or satisfactory. B
Y
ThB pemdt hClder understarWs and sprees that the City shall have the right to make periodic inspection
durlnpCOn89UCtkn.H1hepennitt~okSSr does not make arrangement to the inspection the City may Cum
oft theweterunt~suchinspeCtionhasbeenrnade.
.r~. ~ 0`~3 S~
Nut, -
/ S~~
~ ~
~
o~ ~
CzTY OF LAKEVILLE
SEWER AND WATER PERMIT APPLICATION
~ ~ Date /r~j~ ~ z 2 ~S~
/ / - ~
Job Site Address ~ (O ~ ;,Z Tf~/,ri ~rf
Legal: Lot Block Additio//n
Owner or Builder ~6 ~i e r" ~ .CIS':
Excavating Contractor f 0 : ~ Tel.,~s9 `3G T.S~
Address ~3 City ~,Jls Zip
Private Sewer System ($29.50 + ,50) $
Private Sewer Repair ($14.50 + .50) $
0
City Sewer & Water Connections*(29.50 + .50). $ ,~D ~
Inside Plumbing Conversion (15.50 + ,50)• $
Sewer Connection Only ($14.50 + .50). $
Water Connection Only ($14.50 + ,50). $
Meter ($60.00) & Pressure Reducing Val~re. $
* Metro SAC Charge S/W Connection Units $
0
TOTAL CHARGES $ ~ D
i
i
Is Street Excavation necessary? Yes
No
Signed ~~~~Y~;~%t-Y /G~~CU~-------
i
i
Make checks payable to: City of Lakeville
Send payment to: City of Lakeville Glenn A. (Barney) Langord
Ins ection De t. Plumbin ~ Heatin Ins ect.
P P g g P
Box 957
Lakeville, MN 55044 Tel: (612) 469-4431