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3314 Alden Pond Lane SEWER St WATER PERMIT OFFICE USE bNLY CITY OF EAGAN ' PERti T DATE 6/ 3830 Pilot Knob Rd. ' WATER PEFMI,NT # 10555 3E'1 i %PERM1T # P.O BOX 199 METER B R EIPT # C 1628 Eagan, MN 55121 ,-, READER,# B.P. RECEIPT DATE 4124.../g9 itlETER SIZE ; ISSUE, DATE xx PRY— BOOSTER PUMP SITE ADDRESS 331 1 en POnd Lane , RMIT ` ` D tOT ' - SEC/SI fi r: PPLt Rosewood t onstruction Inc . ____ SEI NER " ' . WATER .;> TAPS `ADe ,: 17I N. County KO. . :13 CCTV, STATE , Rosevi11e� „i ' ZIP X113 IND ____ RESIDENTIAL 631 -32'4 t NE: {f s- = EXISTING PLUMBER: Major Me h*ni.ca1. ; ADDRESS: 10650 Iii hwaZir 152 1 AGREE TO COMPLY WITH CI'T'Y OF CITY, STATE Maple drove, . MN Zip 55369 EAGAN EAGAti ORDINANCES: 1 !PHONE: 424;.6680 OWNER: . 121111 22 2& T.iini ted ?a•triership ADDRESS: 1711 If. Ctiunty Rd; .' CITY, STATE Roseville, MN Zip 55113 .SIGNAT tE'WHEN ME 5R ISSUED PHONE: 636 8QStk,<; ALLOW TWO-W DA1IS OR PROCESSING. FOR STORM` :PERMITS, OONTACT ENGINEERING DEPT. " g� l � �0 ,, ,_ � '�� ' � Use BLUE or BLACK Ink �j� � • �' , � For Office Use ---------j � • ' ��-�� . . . �. �:.��C�ty.:of`Ea�a� � Pertnit�: � �� I . � Pertnft Fee. � I . 3830 Pilot Knob Road � i Eagan MN 55122 . I Date Received: � � Phone:��(651)675=56T5 � j � � Fax•'{651).675-6694 � scaiF. � , ' ' �� J . 2Q1�4 RESIDENTIAL PLUMBING PERMIT APPLICATION ' Date: Site Addreaac • Tenant: � 3ufte�k: `�.�°�;,' a �� ° � a �' a �^ .�� 5 �L '• � i� 4 ^�� ' ��` � r �'��'��'� tf �Name: aC �G�. Z Phone: �D�l"3.$�o�`��y ��F�es�dentlOvw er'�� . . '�� ;�� ;`�� p ,�� .'"��`�,� t�. ' ,� Address�'CitylZip:� 33/Y �¢l�evt `o'rt La rt � ��,�� F��`��`k��",�° .Milbert .ompany Inc dba Cullign Water �' `�`� WC643176 ��b�,s��t�� Name: ' . . ucense#: y �` '� " � �� 180150t. Street East� fi�`��F�' ��x ' tf�� Address: c;ri: Inver Grove Hgts. �^�'.a-��y COf1tf�3C O , ��;��' ` ss �' 651-451-2•241 ,� ��,�,� '�;. , ��,��,�� , ��. � ��. State:. ,NiN Zip: 55�77 Phone: . �.�}:��, ��: s�,� � �; , . :�� -- �n�� .co��c:. Wiiliam�.R'Milbert Ema��: ��` �� . :� . �� T e of�N��lo New _Replacement _Repair _Rebuild _Modify Space _Work in R.O.W. ��`� yP � � �, . �� f� :.. � �. . , �,, ;`* �� : ,, Description'of work: �a��'s�� `� � RESIDENTIAL . r�;� `�� +�4�, . � �'' . k��'�t4 ^��,� �� Water Heater c4�� , � � . ��_ �ti �.,�� '. ,, . Water Softener �,�i� �� Lawn Irrigation�RPZ/_PVBj � Per�I��/�� . Add Plumbing Fixtures(_,_,Main/_Lower Level) ��,�'�:z.�ti� : Sep.ic�y�4ern - �� `�� 'r"� .NeW Water Tumaround * ��'�z� �'. ` � �: �� .r�, � � . �Abandonment .. :RESID.EIdTI.A'�.:`FFES:, � ;:$60i0O INa4er'Heafer;:;lNater Softener,or Water Heater and Softener(includes$5.00 State Surcharge) � ` :�$60:00.E,ainin'�Irrigation:(includes$5.00 minimum State Surcharge) �_$SQ:OO.Qdd'I��utj��iirig��Fixtures,Septic System-Abandonment,Water Tumaround*(indudes$5.00 State Surcharge) � : ..: : .. � " , :. :"V1later'rl`uriiaround(add$200.00 if a 5/8"meter is required) ' ., „ .- -:.� ,. _. ' '�115.OD�.Septic:SY§ferti�New($10.`00 per as�:built)�ncludes County fee and$5.00 State Sutcharge) PJ� , , . _ . . � .:•S . . � TOTAL FEES 3 :`C�ALL".`BEF:C;R�:�CSU DIG, Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. � Cal1:4fl�hours'bYfar�`you ir�tend to digto receive`locates of undergrourtd utilitie3. www aopherstateonecall ora f�:li�reby sckhbwledgq`lliat_thia infcrma:fon is complete and�axurate;that the work will be in confortnance with the ordinances and codes of the Ciry oi : �a�an;.'.fhat')'understapd:this is not a.permi�but ony an application for a.permtt, and work la not to ataR without a permit;that the work will be in :�accordance:witt#.:fib.8�ptoved plan in the case of workwhich requirea a roview and app v I of plans. _ F. I . , ` • ..y .��' . , �a .. .�,. �� .. �: a J�iN�..' .•� ( ... .. •. • .i� . . 4.�i1.,� `�i ' � ..,........ x . . �ppplicant s nted Name AppUcant's Signature > , - '��.� � a . �. '�Q�r�� ' ��::v �� Re iQw "�' �1 at �' �� O IC � �,� �*�� ,�. � �, �;� . ;�F �kx�� .�.� � '�� -� ,e�'�, � : fA�r ;. Requi�'��ns_ec�iq,ns=! '��'�� t,�.,';; � q, d �, �. ;i a °n�,� .��#' F� �� ..��z '}�uif�. . � ' ., R�.�i� ; p�� a;� [VI�"ter�' el�ate Iter��s�. �t Nl.ete �ze� , � . ' ,. .2 . � ...: . ..:..... ...:: .. ; ; " #��.�._.��.� ,.vx, � . .. ....�.. �..: _ � �... ,.3�.,�,. �