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4500 Cinnamon Ridge Tr ��' Use BLUE or BLACK Ink '�,',,. � r________________i I For Office Use � • � Permit#: � �/�`�L � City of ����� � �-�c� I Permit Fee: � 3830 Pilot Knob Road � Eagan MN 55122 � Phone: (651)675-5675 i Date Received: � Fax: (651)675-5694 � � � Staff: i �-----------------� 2015 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES EXISTING COMMERCIAL PROPERTY � ; �1j � �{ r�� Date: (. l � � ��,��� � �� ��` „.� b �. � Property Owner: � ��Gc_ � � �� �1�--S �� ;. __ . � ,. _ � � ) �� �l�-"a,-`"�6� l�' � hone Number: � '��� � �� �:_ � Address: � �� � � ������� �� � � . � � <� ��: � � �� ��rmit ����, �+mF�p P Plumber: ' Contact Name: ��.,,f��...��- „ �$�����p " qi�" i�*�tk�''�t�����;°�`�"�j���������d���;i � ; � �n � �, � �. W �N,t�P� � ` �' ,�: � � ,u � , Sewer Service Water Service Sewer lateral charge Water lateral charge Sewer trunk Water trunk City SAC @$100/unit Water Sampling Fee MCES SAC @$2,485/unit Water supply storage Receipt#: , Date: Receipt#: , Date: Permit Fee $60.00 Treatment Plant @$843.50/unit State Surcharge $5.00 Permit Fee $60.00 TOTAL: State Surcharge $5.00 ' *Plumbing Permit Required—water meter to be ' acquired with building permit TOTAL: � � � m���r�d��s����� �;�,��,��,�a������u�!�' _ ��������i��a���i���a� n ��.������r����: `���✓ ` �:� ��� �:� Sewer Service Water Service Sewer lateral charge Water lateral charge Sewer trunk Water trunk ' Water Sampling Fee City SAC MCES SAC Receipt# , Date Water supply&storage Receipt# , Date Treatment plant Permit Fee $120.00 State Surcharge $5.00 �P/umbing Permit Required—water meter to be , acquired with building permit TOTAL: Number of SAC units is determined by the Metropolitan Council Environmental Services (651)602-1000. 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.gopherstateonecall.orq Cc: City of Eagan Finance Department