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City of Lakeville April z3, ~a6
~ ~7~ ~ INSPE~TiON DEPARTMENT
• 39.50
` SEWER AND WAtER PERMIT Permit Fee."""".
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AND RECEIPT state surd}arye .
TOTAL Fff PAID. 4Q.00:
Pdrmission is hereby granted to Hiltner ~lumbintt/Jas Miller Conestruct~.on ,
~uiiding on Lot N0. 21 Block Subdivision Aont,~Y r'B Vallev Park 8th Addis
pareel~2Z-21177-210-11 Plat
in the CITY OP LAKEVILLE to be used as hermit to connect to citg water and sewer ayst~m
.This permit is issued on the express condition that the -ERECTION .-,..ALTERATION -.REPAIRS
' INSTALLMENT .eMOVING -DEMOLITION respects io the statetKaents certified to in the application for
sueh ptairrr}it, and that all work shall be done in accordance with the OPdinance of LAKEVILLE, Minnesota and ttie State
of Minnesota pertaining to the construction of buildings.
Street Address 1 h 398 F>ant-_asei a_ Avemtet ~1 ~r~ A L-an~n'1Cd
Attention i6 pertlctriaAy ca1Wd to the cutting uP of streets, making main sewer connections. driveways and Dir~ctOr, (.ic~nse •nd Inta:pec}t01f
curbs. Obtain permit for such consKuctbn from the CITY OF ~AKEVILLE. Inspection Department Not
4?esponaible For Any Damages to Pubkc UtiNnes.
The permit holder understands end agrees that flrenting this permit is not a werrarity or representation by
the City that the project wit be safe or satisfactory. B
Y
The permit twWer understands artd egress chat the City shall have the right to make periodic inspection
during construction. H the pertnft holder door not make arrangement for the inspection the City may tun
off the water until such inspection has been made.
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CITY OF LAKEVILLE
.SEWER AND WATER PERMIT APPLICATION
Date l ~D
Job Site Address
Legal: Lot Block Addition
Owner or Builder
Excavating Contractor Tel.~.~~-~ ~ SC}
Address ~ s-~„~.- v,~,
/l~ l ~ ~ City 1`~-~-~-~~ ZiP 3~
Private Sewer System ($39.50 + .50) $
Private Sewer Repair ($19.50 + .50) $
City Sewer & Water Connections*(39.50 + .50). $ ~ O
Inside Plumbing~Conversion (19.50 + .50)• $
Sewer Connection Only ($19.50 + .50). $
Water Connection Only ($19.50 + .50). - $
Meter--($60.00) &-Pressure Reducing Value. $
* Metro SAC Charge S/W Connection Units $
TOTAL CHARGES $
Is Street Excavation necessary? Yes
No
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Signed
Make checks a able to: Cit of Lakeville
P Y y
Send payment to: City of Lakeville ~ Glenn A. .(Barney) Langord
Inspection Dept. Plumbing & Heating Inspect.
Box 957
Lakeville, MN 55044 Tel: (612) 469-4431