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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