EA182837 - Sewer & Water - Residential - Issued Date 05/11/2023 PERMIT
City of Eagan ® ® Permit Type: Sewer& Water
3830 Pilot Knob Rd ®®�® ® ® ®;® Permit Number: EA182837
Eagan, MN 55122 ®®®® m®®®
EAGAN
(651)675-5675 11111111111111111111111111111111111111111 IN IN
* E R 1 8 2 8 3 7
www.cityofeagan.com
Date Issued: 5/11/2023
Site Address: 3763 Brown Bear Tr
Lot: 12 Block: 3 Addition: Blackhawk Forest
PID:10-14325-03-120
Use: * 10 — 14325 - 03 — 120 *
Description:
Sub Type: Residential
Work Type: Sewer Only
Description: Repair
Meter Size Meter Type 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:
Krueger Excavating Inc Mary Jane Pedersen
P.O.Box 729 3763 Brown Bear Tri
Prior Lake MN 55372 Eagan MN 55122
(952)447-8335
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.
I 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
----------------,
® e I For Office Use
"%� ��� j Pennn#: 182837
Permit Fee:
E A C"IA N I
Date Received: 511/23
I I
I
�—Staff----------------�
2023 SEWER & WATER PERMIT
Date: 5-11-23 Site Address: 3763 Brown Bear Trail
Propefty Name: Mike Sylvester Phone:
't9rttar' 3763 Brown Bear
Address/Gity2lp:
Name:
Krueger Excavating Inc Lleense#: PB658581
Con�a�r
Address/city2ip:7616 180th st E, Prior Lake MN 55372
Phone:952-292-0154 Email: tracy@kruegerexcavating.COm
Pipelayer Training Certification#. PB658581 or Master Plumber License#:
Property Use: Type of Service: Type of Work:
0 Residential ❑Sewer&water ❑ New
❑Commercial 0 Sewer Only 0 Repair,Description: repair sewer service
a
❑ Public Facility ❑Water Only ❑ Disconnect
❑ 1 understand that new water connections require a separate Plumbing Permit and associated meter fees,
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 lose of work which requires a review and approval of plans.
xTracy Krueger x
Applicant's Printed Name Applicant's Signature
►R"bFIFICE,USE
' SIJ
t"et 7f1Nj onas $ewer,C7ni1+
SeWarPai { .fa"rAir lest 11 ,
Water Est}tit#t; Bd. Q} ". Manttraai Tot `
S&W Repair/Distannect($80.00) Sewer Liners Televisaad
Sewer lateralverify Meter ConOg tration
Sewer trunk Water Only
Water supply'8 storage Conductivity Test
Water lateral; Hydrostatic Test
Water trunk Bacteria Test
City SAG($t 3t3,t401SAC unit) Stead Pipeinspection
Met C+o6Ci[QACiM151SAG unity . Wet Tap
Trey#rnenPtan4 ,9k11pAGiihitj h . i
Stats surfiarge $?:tit) Adeitivrrdt RegtpfreMs;
Total: Tri lit`uegsr City R-?-V1i Pdtttt
f
County R-0-W perntlt
Plumbing Permit p
PRV Required'
3830 PILOT KNOB ROAD i EAGAN,MN 55122
(651)675-56751 FAX(651)675-5694 buildinainsosctions(alcitvofeaoanxorn
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