EA186458 - Sewer & Water - Residential - Issued Date 09/26/2023City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.cityofeagan.com
Site Address: 4385
Lot: 000 Block: 005
PID:10-02500-05-012
Use:
Description:
Sub Type: Residential
Work Type: Water Only
Description:
PERMIT
• & A d
w e
• • i e A AEAGAN
.• A
South Robert Tr
Addition: Section 25
Permit Type: Sewer & Water
Permit Number: EA186458
111111111111111111111111111111111111111111111111
* E A 1 8 6 4 5 8*
Date Issued: 9/26/2023
111111111111111111111111111111111111111 11111111111 IIIIIIIIIIIIIIIIIIIIII 179
0 0 2 S G O 0 0
Meter Size Meter Tvpe 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: City SAC (01 Unit) $139.00 9376.4681
Surcharge -Fixed $1.00 9001.2195
SW - Water Permit $80.00 6101.4507
Total:
$220.00
Contractor: - Applicant - Owner:
Xcel Energy Jeffrey L Black
414 Nicollet Mall 4385 Robert Trl S
Minneapolis MN 55401 Eagan MN 55123
(773) 677-4574
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
2023 SEWER & WATER PERMIT
Date:
7/26/23 Site Address: 4385 Robert Trl S, Eagan, MN 55123
Property Name: Xcel Energy Phone: 773-677-4574
Owner Address/City/zip: 414 Nicollet Mall, Minneapolis, MN 55401
Xcel Energy....��,...v.............u..�� ���,.�
Name: License #:
Contractor
Address/City/zip: 414 Nicollet Mall, Minneapolis, MN 55401
Phone: 773-677-4574 Email: george.r.wojcicki@xcelenergy.com
Pipelayer Training Certification #: or Master Plumber License #:
Property Use: Type of Service: Type of Work:
V1 Residential ❑ Sewer & Water {� New
❑ Commercial ❑ Sewer Only ❑ Repair, Description:
❑ Public Facility V3 Water Only ❑ Disconnect
1L! 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.
Digitally signed by George Wojcicki
DN.0=US,
E=george.r.wojcicki@xcelenergy.wm, O=XcelGeorge Wojcicki George Wojcick
Energy, CN=George Wojcicki
X X --Date: 2023.07.26 10:29:28-05'00'
Applicant's Printed Name 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
City SAC ($139.00/SAC unit)
Met Council SAC ($2,485/SAC unit)
Treatment Plant ($1,126.00/SAC unit)
State Surcharge
Total
FOR OFFICE USE ONLY
Required Inspections:
Tj
$1.00
George Wojcicki
�ZZv—
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
Additional Requirements:
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 i FAX: (651) 675-5694 buildinginspectionsCcD-cityofeagan.com
If you have a hearing or speech disability, contact us through your preferred telecommunications relay service.