EA187765 - Plumbing - Water Softener - Issued Date 10/30/2023 PERMIT
City of Eagan , , o Permit Type: Plumbing
3830 Pilot Knob Rd +;® ;✓, Permit Number: EA187765
Eagan, MN 55122 EAGAN
(651)675-5675 111111111111111111111
www.cityofeagan.com * E R 1 8 7 7 6 5
Date Issued: 10/30/2023
Site Address: 865 Lakewood Hills Rd N
Lot: 1 Block: 0 Addition: Lakewood Hills
PID:10-44350-00-010
Use: * 10 - 4465 >2 00 0 10
Description:
Sub Type: Water Softener
Work Type: Replace
Description:
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: PL-Permit Fee(WS&/or WH) $64.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
Total: $65.00
Contractor: - Applicant - Owner:
Milbert Company(Culligan) Gustav H Jr&Audrey Degler
1801 50th St E 865 Lakewood Hills Dr
Inver Grove Heights MN 55077 Saint Paul MN 55123-491
(651)451-2241
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
r-----------------,
For Office Use
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�*. j Permi
Permit Fee:
� I I
I I Date Received: l
()S�tt�rti( l fJOf3 ROAD I EAGAN, MN 55122.1810 I l
FAX: (651)675.5694 I l
Staff:
r!I�4�IrrI arra fions(cJcilyofeaCtan com 1-------- — I
_ RESIDENTIAL PLUMBING PERMIT APPLICATION
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Address:
[-� U it A;
1 i r ?+T,!t ❑ Ov%ner Contractor
i I' ^Name: I
i
A
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Address: City:
Slate:_ Zip:
I f1 r r 1Y irk` New Replacement Repair Rebuild Modify Space Work in R.O.W. -
Description of work:
3 Tannkless Water Healer
Standard Water Healer Lawn Irrigation ( RPZ/_ pVB)
1 ;i } t4IJ, t 11 t1 ✓ Water Softener Add Plumbing Fix(ufes C_Main/�Lower Level)
Septic System Description; _
New _Abandonment ---Connection to City Water from Well
y Company: MIL ERT COMPANY dba CULLIGAN BILI- MIL�3ERT
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Contact:
f T."!}lltl r,rrg Address: 1801 SOTH STREET EAST INVER GROVE HEIGHTS
_ city:
r111r ' r MN 55077
{. State: Zi 651-451-2241
P PhSERVICE@C'ULLIGAN4WATER.COM
Phone: Email:
`
License tt:
WC643176
l -- -- - Expiration Date;-
_
ter i,`I11(`1'{Il1L ,FEES
Residential or Connection to City Water(includes Stale Surcharge)
r.er l,1boter, Water Softener, or Water Neater and Softener(iilclud,s-Slaie-Surcf)arge) -
x;}{l a •t l n-Irrigation'(iMcludesState Surcharge)
0.1 n 1 i fixtures,adding, altering,or removing piping (includes State Surcharge)
t,r tl yfrr;+ISeplic System.(includes County fee and Slate Surcharge)
ra l (ts =r itllic System Abandonment(includes State Surcharge)
t TOTAL FEES
YOU DIG. Contact Gopher Slate One Call at(651)454.0002 or www.nopherstate 2!2tcatl.ora for protection againsl underground utility�
b ii{ r+ se!,rel Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities,
r .i'r 4 k y r`4 i,Nledge that this information is complete and accurate; 11131 the work will be in conformance with the ordinances and codesof lire City of
S' �mdersland this is 1101 a permil, but only an application for a permit, and work is not to start without a
the approved plan in the case of work which requires a review and a permil; that the work will be in
r pproval f p n .
Name — -- --- ' ----
Applicant's Signature
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-Re viawed,t3Y _ rDate;•
npplrcaFlel)
r+t�o-'f rf ll;pecCions Under Ground hough f^_���i Air Tcst Gas Test Manometer Final
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