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EA186478 - Sewer & Water - Residential - Issued Date 09/01/2023 PERMIT City of Eagan x , Permit Type: Sewer& Water 3830 Pilot Knob Rd ®+' _ ®, Permit Number: EA186478 Eagan, MN 55122 -•® •-° EAGAN (651)675-5675 www.cityofeagan.com * E R 1 8 6 4 7 8 Date Issued: 9/1/2023 Site Address: 4555 Lenore Lane Lot: 121 Block: 2 Addition: Clearview PID:10-17750-02-121 Use: * 10 1775 (!7 - 02 12 1 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: $81.00 Contractor: - Applicant - Owner: Bomstad Enterprises Inc Peter Lilja-Sheeley 350 97th Lane NW 4555 Lenore Ln Coon Rapids MN 55433 Eagan MN 55122 (763)226-4898 This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. 1 hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature -----------------1 For Office Use ^LG I i� j Permit#:EAGAN I � 1 1 •��� •mss• I � � � '_ I Permit Fee: Date Received: I 1 I Staff: I L----------------� 2023 SEWER & WATER PERMIT 09-01-2023 4555 Lenore LN Date: Site Address: Peter Lija-Sheeley 612-508-5204 pry, ry Name: Phone: Owner 4555 Lenore Lane Eagan, MN 55122 Address/City/Zip: Bomstad Enterprises, Inc PB753725 Name: License#: Ct1t1'BC�Or Address/City/Zip: 350 97th Lane NW Coon Rapids, MN 55433 O , 763-226-4898 djb@bomstadenterprisesinc.com Phone: Email: 9110 Pipelayer Training Certification#: or Master Plumber License#: Property Use: Type of Service: Type of Work: ❑ Residential ❑ Sewer&Water ❑ New Repek broken wwm k 3f from dean M wM Wwbadw mW 4.9Wtl Wre$W*A*b P. ❑ Commercial 0 Sewer Only 0 Repair, Description: ❑ Public Facility ❑ Water Only ❑ Disconnect ❑ 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. Donald Bomstad X X Applicant's Printed Name Applicant's Signature FOR OFFICE USE ONLY Fees: Required In$pecg": Sewer Only Sewer Permit($80;00) Sewer Air Test Water Permit($80.00) Mandrel Test S&W Repair/Disconnect($80.00) Sewer Lines Televised Sewer taterat Verify Meter Configuration Sewer trunk Water Only Water supply&storage Conductivitylest Water taterat. Hydrostatic Test Water trunk' E3actetia Test City SAC($138.00/SAa'0n } Stand pipe lnspoo v . Mef Council SAC{S2,4S35/SAC unify Wet Tap Treatment Plant($11 26.,00/SAC unit) State r04 :$1.90 Additional Requirements. Total: Donald Somstad City R-C3»W"t�erntit County R-0-W Kermit Plumbing Permit PRY Required 3830 PILOT KNOB ROAD I EAGAN, MN 55122 (651)675-5675 1 FAX: (651)675-5694 buildinginspectionsa-citvofeagan.com If you have a hearing or speech disability,contact us through your preferred telecommunications relay service.