1962 Shale Lane*City
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
C
Use BLUE or BLACK Ink
Permit #: 0 0 / 57 '
Permit Fee: `i+' SS ®V
Date Received: 7-N-11
- /
Staff:
INFLOW INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Site Address:
Tenant:
vb -1,),_0-4202-1 Kyo
Suite #:
RESIDENT / OWNER
Name: &4 Wd Phone: (,$)-b rt' -`32-2-10
Address / City / Zip: i? & r S 0-1-€. )(. A- Ca c ' Al 65 / 9 ----
CONTRACTOR
Name: —34 -*License #:
Address: City:
State: Zip: Phone:
Contact: Email:
TYPE OF WORK
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
) Sump Pump Repair Repair
Other: Other:
DESCRIPTION
Description of work: i 11--r' Li-Ia./4p1 pL Q i s l Cry " n 1 T'
FEES
$55.00 / Each (includes
$5.00 State Surcharge) (Rev. 6-30-10) TOTAL FEE $
*
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeaqan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call
48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans.
xl�w' "" "ice✓
etD
Applicant's Printed Name
Applicant's Signature
CITY QF I AN WATER SERVICE PERMIT
379f /2t Knob Road PERMIT, $
Eagan N 55122 DATE: B t
Zoning: PT No. of Units
Owner- Sons Corstruc ion
Address
Site Address- 1962 Shale Lane 15 B4 Neaflowlands
Plumber: 'av:ir' f. David (Sout' itown:) / '
Meter No.: Connectio Qharge• 4.0.00 pd
• Size: Account ,!posit:
Reader No. Permit Fee:It? .00 pd
1 ogre* to comply with the City of Eagan Surcharge. .50 pc!
Ordinances. Misc. Charges: 60.00 pd mete
Total:
By Date Paid-
Date of Insp.: _______7421172.. Insp •
crrY of..-EAciCN
3795. t'Knob Road
Eagan, Mg 55122
Zoning: 'RII
SEWER SERVICE PERMIT
5372
o. of &Jnit •
Owner Sous Gonstrut on
1 duplex
Address:
1
Site Address: 1962 Shale Lane L5 84 Thea ow3l.ands
Plumber: Dayid & David,t(Suthown)
10/28/82 327124 1?4.. ?� 100.00 pd
i aims to" ply with the City of Rogan Connects wow 1 425.00 pd
10.00 pd
Ordinonoes.. ,
Peccounii Dep4sii•
rmit Per
Surcharge. .50 pci
By Misc. Charger'
i
Date ;/ s.% Tota/ ' '3 �� Dae P. d:
Insp.:
Date:
1oDflU-j2
City of EaallTot\fOWX'
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Resident/
Owner
Use BLUE or BLACK Ink
For Office Use
Permit #: I 1?0,Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL
, BUILDING PERMIT APPLICATION
, 3 Site Address: 1 1(0 0 9/ )°,6E 2 S k.til�CJ - LVL 'Unit #:
O&,vNiLe.one:
Type of Work
Name:
Address/City/Zip: 1quoP IGDL- SY L_
Applicant is: Owner PC Contractor
Description of work:('p V -C--
Construction Cost: 4CASq> Multi -Family Building: (Yes / -No )
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber:
Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnes9ia�State kilding Code must be completed within 180
days of permit issuance.
x
Applicant" Printed Name
App ant's Signature
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