EA185365 - Sewer & Water - Residential - Issued Date 07/20/2023PERMIT
City of Eagan
, ,
Permit Type:
Sewer & Water
3830 Pilot Knob Rd
Eagan, MN 55122
, ®
EAGAN
Permit Number:
EA185365
(651) 675-5675
111111111111
www.cityofeagan.com
o+
* E R 1 8 S 3
6 S
Date Issued:
7/20/2023
Site Address: 4100 Nicols Rd
Lot: 2 Block: 2 Addition: Cedar Grove 1st
PID:10-16700-02-020
Use: * 10-16700-02-020*
Description:
Sub Type: Residential
Work Type: Sewer Only
Description: Repair
Meter Size Meter Tvne 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 Patrick William Hueller
14530 27th Ave N 4100 Nicols Rd
Plymouth MN 55447 Eagan MN 55122
(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.
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
L M -7 /Z -O
Date: Site Address: W00 A,I Lc6 5 �
a -
F
Property 9 Name: l r,- Phone: 15�2 -;23gi
Owner
Address/City/Zip: Vic; fit Mf\.) �- �-i -;k a ,
Name: t'C7 'rt`�1� License #:
Contractor Address/City/Zip:L� � r j'yl, P 5 5 tfGt �
Phone ( �7 t'S �7i7 Email: taiG� 1" lc _. �'(p 1'1 V) a�^c P—p—SC.-C c Epi
Pipelayer Training Certification #: or Master Plumber License #:
Property Use: Type of Service: Type of Work:
PQ Residential ❑ Sewer & Water ❑ New
❑ Commercial ewer Only A] Repair, Description�li i I-, kc,-rALr t o +O in f
❑ Public Facility ❑ Water Only ❑ Disconnect ��h 5 Y`t' I -e mac'' P UL
❑ I 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 case of work which requires a review and approval of plans.
Applicant's '
Printed Name— �r f4_ �'�
/ Applicant's Signature
Fees:
Sewer Permit ($80.00)
Water Permit ($80.00)
S&W Repair/Disconnect ($80.00)
Sewer lateral
Sewer trunk
Water supply & storage
Water lateral
Water trunk
FOR OFFICE USE ONLY
Required Inspections:
City SAC ($139.00/SAC unit)
Met Council SAC ($2,485/SAC unit)
Treatment Plant ($1,126.00/SAC unit)
State Surcharge $1.00
Total:
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
Wet Tap
City R -O -W Permit
County R -O -W Permit
Plumbing Permit
PRV Required
3830 PILOT KNOB ROAD I EAGAN, MN 55122
(651) 675-5675 1 FAX: (651) 675-5694 build inainsoections aOcitvofeacan corn
If you have a hearing or speech disability, contact us through your preferred telecommunications relay service