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: $81.00
Contractor: - Applicant - Owner:
Bomstad Enterprises Inc Peter Lilja-Sheeley
350 97th Lane NW 4555 Lenore Ln
Coon Rapids MN 55433 Eagan MN 55122
(763)226-4898
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
1 hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature Issued By: Signature
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For Office Use ^LG I
i� j Permit#:EAGAN I �
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Permit Fee:
Date Received:
I 1
I Staff: I
L----------------�
2023 SEWER & WATER PERMIT
09-01-2023 4555 Lenore LN
Date: Site Address:
Peter Lija-Sheeley 612-508-5204
pry, ry Name: Phone:
Owner 4555 Lenore Lane Eagan, MN 55122
Address/City/Zip:
Bomstad Enterprises, Inc PB753725
Name: License#:
Ct1t1'BC�Or Address/City/Zip: 350 97th Lane NW Coon Rapids, MN 55433
O ,
763-226-4898 djb@bomstadenterprisesinc.com
Phone: Email:
9110
Pipelayer Training Certification#: or Master Plumber License#:
Property Use: Type of Service: Type of Work:
❑ Residential ❑ Sewer&Water ❑ New
Repek broken wwm k 3f from dean M wM Wwbadw mW 4.9Wtl Wre$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
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