3258 Dodd Lane VILLAGE OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.• Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the Village of Eogan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.: Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By: Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
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3830 Pilot Knob Road � i
Eagan MN 55122 � Date Received: �
Phone: (651) 675-5675 � �
Fax: (651) 675-5694 I Staff: I
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2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: � 2' ' Site Address: � � � e„L/p�{'� � ��"� J�`��L- �
Tenant:
Suite#:
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R�S1den#��nG�ae[ Name: �d`1 /' �c.L1� Phone:�3%=�`�'�- �s �
Address/City/Zip: �l�� CF� �f�'L �
' Name: � ,� `11 G �"Cicen es #: .__. -
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+Gt�ntr�Ctor � �� � Address � 0 �� f2�/�o �1 � ""�� V�P City:� �QSP �� 1��
� State��V' Z����,��_ Phone: ��7� '�'�� 2-TJ�J ���
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Ty�e i�'��II�Ork —New V Replacement _Repair _Rebuild _Modify Space _Work in R.O.W.
' Description of work:
< RESIDENTIAL
V Water Heater
- = Water Softener
Lawn Irrigation(_RPZ/_PVB)
���������� Add Plumbin Fixtures
Septic System 9 �Main/_Lower Level)
New Water Tumaround
_Abandonment ��i
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic Svstem Abandonment, Water Turnaround'`(includes State Surcharge)
"'Water Turnaround(add$210.00 if a 5/8"meter is required)
$115.00 Septic Svstem New(includes County fee and State Surcharge) � ��
TOTAL FEES$ �
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)4540002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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.
X �� ��-�-�
Applicant's Printed Name plica 's Signature
�(�R UFf1C�USE Review�d By: Date:
Required Inspec#ions: Under Gro�nd ` Rough-!n Air Test ' Gas Test Finai
Meter Related Items: Meter Size ftadio Read Manvmeter Staff: