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EA186478 - Sewer & Water - Residential - Issued Date 09/01/2023 (2) PERMIT City of Eagan • , , R Permit Type: Sewer& Water 3830 Pilot Knob Rd •�+;•� Permit Number: EA186478 Eagan, MN 55122 ••e• �- EAGAN (651)675-5675 111111111111 IN 1111111111111111111111111111111 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 11111111111111111111 IN 11111111111111111111111111 im Use: * lid — 177S0 - 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. 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 Issued By: Signature ----------------- For Office Use I � 0 j Permit#: EAGAN I Permit Fee. O I I Date Received: I l I Staff: I L----------------� 2023 SEWER & WATER PERMIT 09-01-2023 4555 Lenore LN Date: Site Address: Peter Lija-Sheeley 612-508-5204 P1OY Name: Phone: Owner4555 Lenore Lane Eagan, MN 55122 Address/City/Zip: Bomstad Enterprises, Inc PB753725 Name: License#: 350 97th Lane NW Coon Rapids, MN 55433 Contractor Address/City/Zip: 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 %pak broken aewwAt 3W bran dean as wlm ffi baft end a^sold cora a&."e0 pre ❑ Commercial 0 Sewer Only 0 Repair, Description: ❑ 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 case of work which requires a review and approval of plans. Donald Bomstad x x Applicant's Printed Name Applicants Signature FOR OFFICE USE ONLY Fees: Required Inspections: Sewer Only Sewer Permit($80.00) Sewer Air Test Witter Permit($80.00) Mandrel Test S&W RepaidDisconnect($80.00) Sewer manes Televised' Sewer lateral Verify Meter Cnniiguration sewer trunk Water Only Water suppfyr&storage Conductivity Fest Water lateral Hydrostats Test Water trunk.` t3acteria Test City SAC($i 39.0015AC Stand'Pipe lnsp ©n Met Council SA ..($2, [�AC unit) UUet Tai Treatment F'ia44!112S.0t11SEC state's $1.00 Additional R uirements: Total: Donald&Dmstad City 1141 W Permit County:W- 'WIPeCmi# Ptumbingp permit PRVI Required 3830 PILOT KNOB ROAD i EAGAN, MN 55122 (651)675-5675 1 FAX: (651)675-5694 buildinginsoections(&-citvofeagan.com If you have a hearing or speech disability,contact us through your preferred telecommunications relay service.