EA181409 - Sewer & Water - Residential - Issued Date 02/21/2023City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.cityofeagan.com
Site Address: 1030
Lot: 1 Block: 2
PID:10-47750-02-010
Use:
Description:
Sub Type: Residential
Work Type: Repair
Description:
Kenneth St
Addition: McKee
PERMIT
Permit Type: Sewer & Water
®® ®r.. ® KI Permit Number: EA181409
* E R 1 8 1 4 0 9*
Date Issued: 2/21/2023
* 1 0— 4 7 7 5 0— 0 2— 0 1 0
Meter Size Meter Tyne Manufacturer Serial Number Remote Number Line Size
Comments: Please call Utilities at (651) 675-5200 for water turn ons, shut offs and meters.
Please call Engineering at (651) 675-5646 to schedule inspections.
Fee Summary: Surcharge -Fixed $1.00 9001.2195
SW - Sewer Permit Fee $80.00 6201.4532
Total: $81.00
Contractor: - Applicant - Owner:
Roto Rooter Elizabeth J Rolfes
14530 27th Ave N 1030 Kenneth St
Plymouth MN 55447 Eagan MN 55121
(763) 519-3977
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
1 hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature ssued B : Signature
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s I For Office Use I
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Date Received* i
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Staff:
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2023 SEWER & WATER PERMIT
bate c�b'a Site Address. I o Z Q 1` ti ka e4 h S �
Property Name:(
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Owner Address/City/Zip: Iia ke h in e-1 h Px _
Name -%40- ey- License # C a VRO
Contractor AddressiCltylZip:.1 c�3o- a-7 t�9/� '`�f iY�Qti� h ! ► �/7
Phone: tJ 77% Email: Y%L-- i ---e E' YYlil
PipelayerTraining Certification #; or Master Plumber License M I %
Property Use: Type of Service: i Type of Work: ,� t Y, e I % s QDIii S L q C-
t—t Residentialy��ttSewer & Water El New t
L.I Commercial asewer Only Repair, Description
r�tw 'Sec4u-Y, of p t p e- stet Pc- It
❑Public Facility 11Water Only y ❑ Disconnect
I understand that new water connections require a separate Plumbing Permit and associated meter fees.
i hereby acknowledge that thlb InformaUon is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan;
that i understandthis 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 andapproval of plans.
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Applicant's.Printed Name Applicant's Signature
Fees:
Sewer Permit ($80.00)
Water Permit ($80:00)
S&W RepaldlDisconnect ($60:00)
Sewer lateral
Sewer trunk
Water supply & storage
Water lateral
Water trunk
City SAO ($139.001SAC" unit)
Met Council SAC ($2,46a1SAC'unit)
Treatment Plant ($1,126.001SAC unit)
State Surcharge
Total:
FOR OFFICE USE ONLY
Required Inspections:
$1,00 Additional Requirements:
Sewer Only
Sewer Air Test
Mandrel Test
Sewer Lines. Televised.
Verify Meter Configuration
Water Only
Conductivity Test
Hydrostatic Test
Bacteria Test
Stand Pipe inspection
WetTap
City R -O -W Permit
County R -O -W Permit
Plumbing Permit
PRV Required
3830 PILOT KNOB ROAD i EAGAN, MN 55122
(651) 675-5676 i FAX: (651) 675-5594 buildinoinsoecUons(a citvofeaoan com
If you have a heating, or speech disability, contact us through your preferred telecommunications relay service.
IC -I
Labor Amount
Rental
0
Parts Amount
Plumber
Backhoe
Plumber
3
t�
Permit
Rock
Job Total
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