1272 Birch Pt?:-- -_#• CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHaNE: 454-8100
BlxlLDING PERMIT Receipt #
To=ba wed ior B1.D6 Esi. Value Dote , 14
Site iddress d" •
Erect 0_ ?.?¦??? .?
Occupancy
Lot Biock SeclSub Remodei ? Zoning
.
Parcei No Repair ? Type of Const.
. Addition ? No. Stories
Move ? Length
W Name Demolish ? Depth
; Address
b Int. Impr. ? Sq. Ft,
City Phone instail Cl
= F° .
APProrats
Faes
Name
o
u? Address Assessment Permit
F- City Phone Woter & 5ew. Surcharge
F Police Plan Review
FW Name Fire SAC
? Address Eng. Water Conn.
U
tW City Phone P?anner WaterMeter
Councii Road Unit
( hereby ocknowiedge thot ( hnve reod this application ond state that gldg. Off. Tr. Pi.
the intormotion is torrect ond ogree ta compiy with oli applicuble
State of Minnesota Stotutes ond City of Eogon Ordinonces. AP?
Parks
Var. Date ?opies
Sipnoture of Permittee ? ?.
Totai
h Buiiding Permit is issued to: on the express condition tfiat
a!l work sholl be done in accordante with aIl oppiicable State of Minnesoto Stotutes ond City of Eoflan Ordinances.
8uilding Officiol
'?
.
Permit No.
Psrmit Holder
Date
Telephone #
?urnb,ng
k yA.C.
EleCtric r. ? ` ?• ` - '
Softener
(nspection Date Insp. Other
Footings 1
Footings 11
Foundation ?
Framing
Roofing
Rough Plbg.
Rough Htg. s jy r
Insui.
Flreptace
/ -___ ? ,? ?ii _.y %E?..G ? -_•__"
Ffna1 HtB.
Final Plbg.
Final
Cert/Occ.
Water Describe Location:
Wgli
Sawer
Pc. Disp.
f
Permit Mo.
Permit Ho{der
Date
Telephone #
Plumbiog c-
MYA.C. t]rJ;? ?` - ? `i c; S?
Elsctric "1:7171,''j C-
Softener
(nspection Date Insp. Other
Footings 1
Footings 11
Foundatlon ?
Framing
Roofing
Rough Plbg.
Rough Htg.
Insul.
Fireplacs
?
c
Final Htg.
Final Plbg.
Final ?17
C*!t10cc.
Water Dastxibe 4ocation:
Well
Soyvsr
,
Pt'. Disp.
CITY OF EAGAN `
x" 3830 Pilot Kno6 Road, P.O. Box 21-199, Eagan, MN 55121
, PHONE: 454-8100
BIALDING PERMIT Receipt # ?. i'•
YO's,bf Y"d fOI WiESf. VOlU@ 4' ?' r 00{!
Site iddresa 1i: 74! P'..}.CL:T
Lot Block -? Sec/Sub. Fr'3RE:;`3' ?` T i3ief
Parcel No.
Erect 4,
r Occupancy r?j,-?
Remodel [
] Zoning -
Repair ? Type of Const.
Addition ? No. Stories ?
Move ? Length V
Demolish ? Depth
Int. Impr. ? Sq. Ft.
Install O 2r 4€' 0
Approvols Fees
ii? ?
a Name
W
? Address
, „?2"C,+?.4i,
City xtG?'?Phone ?c
? N :1 " - ?:tN C:ORI`
,o
u? ame
Address
Assessment
Permit ? 3 C, 4 • +% ?
?- City Phone Water & Sew. Surcharge 3?:? + v+C`
Police Plart Review 16 4+! 1 l"s
WW Name : ?:`;?C? ?' Fire ?
SAC J 5 t; ;1
?? Address E»p, Water Conn. i
trZu City Phone ??'?''?? Picnner WaterMeter 56a:?<;
Countil Road Unit
I hereby ocknowledga thot I hove reod this opplication ond stote thot gldg. Off. 9 ?10/85 Tr. pL ?. % ?•' ?.?
the informction is correct ond ngree to comply with oil opplicable
PC
0
Stcte of Minnesoto Stotutes ond Ci1y of Eagon Ordinonces. '
` Parks
Var. Date Copies
Sipnoture of Permittee
Total
A Bullding Permit 1s issued fo: on the express condition ttwt
011 work sholl be done in accordame with all applicoble State of Minnesota Statutes ond City of Eo9en Ordinonces. '
Buildirp Officiai
?
?
. ? .
COMTRACT PRiCE:
Site Address
Lot Block
L Name _,L<<, V_U:<<? ,, . 11, n, ,'-l
? Address `{ ? i', ? `?
c City `
?-
Name :
c Address
O CitY -
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
-.w s -. . . . . . .,.y,Wj-. . -.W k
PERMIT# '77,3 9
MECHANlCAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
PHbNE: 454-8100
Sec/Sub?4.:
. S C%' 17 " ,
BLDG. TYPE
Mult -?'
Comm.
Other
WORK DESCRIPTION
New ?
Add-on
Repair
FEES
Phone
M BTU
M BTU
M BTU
4!j M BTU ?
CFM
4
FEE:
SIC:
K a TOTAL:
? RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
? ADDITIONAL 6 M STU
GAS OUTLETS
COMM/IND FEE - 1% OF CONTRACT FEE - 6.00
- 1.50 EA.
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/fND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
- (ADD $.50 S/C IF PERMiT PRICE GOES
? BEYOND $1,000.00)
/
? SIGNATURE OF PERMITTEE
,?'? •?? FOR: CITY OF EAGAN
x
BUILDING PERMIT
N, 2 M 12095
Receipt # ?
To be used for ?OOL Est. Value $20r nOO Date JUNE 10 , 19 A-6
Site Address 1272 BIRCH POINT Erect ? Occupancy
Lot 10 Block 1 Sec/Sub. FOREST '??DG? OPRemodel ? Zoning
Parce i No ?GAN Repair ? Type of Const.
. Addition ? No. Stories
¢ Name ??*E`"j?T RI?E P?TN?SHIP Move ? Length-_ '?
Z ?? Demolish ? Depth _2
o Address ? F
S
int impr. q.
L
City Phone Install ?
s Approvals Fees
o Name ?DI+P?i 0 E"it&`A`IQ
?? Address 3'?05 NO C?'Y ? ?.8 Assessment_
City PLMURone 542"`9000 Water & Sew.
? W Name
0 76 z Address
a W Ciry Phone
Police
Fire
Eng.
Planner
Council
I hereby acknowiedge that I have read this application and state that the gldg. Off. 6/5/86
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. APC
Signature of Permittee j (?"""'-IA ? ,,_.-?_ Var. Date
A Building Permit is issued to: ? ???? ?WL & PATIO
all work shall be done in accordance with aN applicable State of Minnesota Sla
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 71-199, Eagan, MN 55121
PHONE: 454-8100
Permit "'"`W "^"'
Surcharge 10`00
Plan Review 10 - 2 5
SAC
Water Conn.
Water Meter
Road Unit
Tr. PI.
!i Parks
! Cop+es_
I Total 220' ?
on the express condition that
and City of Eagan Ordinances.
Building Officiaf
t Permlt No. Rermit Hoider Data Telephone #
Plumbing
H.V.A.6. -
Electric
Sotteaer
InspecHon Date losp. Comments
Footinqs I
Footings It
Fbundatlon
Framing •'? '?
Rooring
Rou" Plbq.
Rough Htg.
1nsW.
Fireplace
Finat Htg.
Final Pibg.
Bldg. FMaI
C@II. OCC. 7 U/. /? r
Deck Ftg.
Deck Frmg.
Well Describe Location:
Pr. Disp.
?
i Receipt , PLUMBING PERMIT
? Permit No. ?
? CITY OF EAGAN
? Ffll in numbered spaces
f Type or Print legibly
Fee
is/C
Tot.
i 1. Date 2. Instatlation Cost -
? .
' 3. Job Address Lot Btk. f Tract '
i
4. Owner
5. Contractor Phone 6. Address
7. City State Zip .
<
8. Building Type: Resideniial ? Commerciai 13 Institutional ?
9. Work Description: New O Add ? Alter ? Repair ?
'
10. Describe
11
No. Fixtures
Water Closet No. Fixtures
oolJDrainfietd
Cess
Bath tubs p
Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
? 12. 1 hereby certify that the above information is irue and correct, and I agree to
? comply w'sth atl ordinances and codes governing this type of work.
? Signed :
. for
! Rough Final
Inspections: Date Insp. _ Date 1nsp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
l,f ? ? v1 LHUNW fiE:tlldfKS- ?1 vt.?tV1t U lUlJJ u/ uJ
addition ForQSt Ridge of Eagan Lot Bik + Parcel 10-27300-100-01
OwnerI-zv'`? ? StreetL'i.40./_%`t,6!,1.2??`?L-2?T•++1 scate_ , Eaaan MN-55123
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1981 52.98 10 Pd before ivisions
STREET RESTOR. 1077 1986 1402.55 280.51 5
GRADiNG
satv sew TRUNK ,- 1971 "??.60?z 19.05 20 Pd before ivision
?SEWER LATERAL . ? 1981 (?.?? 39.80 15
WATERMAtN 0 r?J- 1981 14.67 10 n n r n
*WATER LATERAL _ 1981
,.._ ..,. 15 n +r r re
WATER AREA 1972 21.73 20
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER '
SIDEWALK
STREET LIGHT
I
Road UNit $7,168.00 54744 9 10 85
,
WATER CONN, I.Z ,$OO.OO
BUII.DING PER, 10928/29/301 31
I
sac 13,440.00
'
PARK
This request void j.1?G^?S"Cr^ ,!„1%) ?-'7j •?? r-'?
18 moaths irom
C 77758 P-C 1-Z?????
Request [late
nj-? Fire No. Rough-in Inspection
Required?
?Ready Now,0 WilI Notifv. lnspec-
[or Wh
R
d
9Yes ?No en
ea
y
licensed Electrica7 Contractor
I hereby request inspection of above
? Owner electricaf work installed at:
Street Address, 6 or Ro/ute No Citv?
l `??,OqGL'
ecuon o. Township Name or No. Range No. Co ity
??
Oc Gan (PRINT)
r Phone No,
) ' ?? 4t ?
93
I.JLt7(rGE `7G'
Y Z-' .
Po? upplier Address
Elec cat Conirac?/ tCompany Name1
?
S
-
, Contractor's license No.
3
(„
l-l..^U? 6.? t F
t
e) L
(t .
Mailing Address (Contractor or Owner Ma ing stailation)
)
?
"?
S
SS113
36
V (,
? /?
I(J
q /L)
Autho d Signature Comract r Owne Making Installationl
=,,?425?+`t?'"` ?? Phone Number "
? -20
M{NNE OTA STATE BOARD OF ELECTRICITY TNIS INSPECTION REQUEST WILL NOT
Grigga-MidwaY Bldg. - Room N-191 BE ACCEPTED BY THE STATE SOARO
1821 Universitv Ave., St. Paul. MN 55104 UNLESS PROPER tN5PECT1pN FEE fS
Phone (612) 642-0800 ENCLO5ED.
REQUEST FOR ELECTRICAL INSPECTION EB-ooo 01-05?
? See instructions for completing this form on back ot yeliow eoRY•
C 77758 ""X" Below Work Covered by 7his Request
Add Re - Typeo! Buiiding Appliances W+red Equipmeni Wired
Nome Range Temporary Service
Duplex Water Neater Lightin,y Fixtures
yL Apt. Buiiding Dryer Electric Heatiit
Commerciai Bldg. Furnace Silo Unioader
Industrial Btdg. Air Conditioner Buik Milk Tank
Farm Other pect y Othpr l5pecify!
t r SUectfy ther . Other -
.mm?rita In.cnnrtinn FPa RnJnw
# r Fee rServiceEntrance5ize #t Fee Feeders/Subfeeders t7 Fee Circuits
0 to200Am s 0 to30Am s 0 tn30 Am s
Above 200 Amps 31 to 100 Amps 31 to 100 A s
.,; Swirrxnin Pooi Above 100_Amps Above 100_..Am s
I Transformers
----- - irrvgation Booms PartiaL`Other
aigns 5peciai Inspectwn
Rern?rks $ Sui ? 70TA1 F ?
.? _I ? . ??
Rough-in
wg 1, the Electri
nSpeCtor, hereby
tif
th
t th
c
b
finat
?
Date er
a
e a
ove
Y
inspection has been
made.
This request void 18 months from
7'BUILD CITY OF EAGAN (? _ 10 9 3 9
3830 Pilot Knab Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454•8100 G PERMIT Recefipt ed ior POOL BLDG Est. Vaiue $77,000 pafe SEPTEMBER 10 t9 $5
SiteAddress 1272 BIRCH POINT Erect El Occupancy B2
FOREST RIDGE
lot 10 Block 1 Sec/Sub Remodel ? Zoning Rt}
.
Parcel No Repair ? Type of Const. y
. Addition ? No. Stories ,2
? Name FOREST RIDGE PARTNERSHIP Move ?
h ?
li
D Len9tn 38
Z 1020 E 14 6TH ST emo
s Depth 3 2
Address
BURNSVILLEph
432-8240
? Cit int impr. ?
? Sq. Ft.
2,'400
y
one Instail
JAD-RON CORP
Name
Approrol:
Fees
?u Address S??ME
u§ Assessment Permit 3671700
City Phone Woter $ Sew. Surcharge 3$ - 50
?'
? pO11Ge
P?an Review 182.00
.
i
JAMES CQOPERMAN & ASSOC
Name
?+ Fire SAC 525.00
?,
„
i? Address SHELARD TOWER Eng. WaterConn. ?QQ,00
tW City p"lPLS Phone 545-0409 Plonner WaterMeter ._90.0
Councii Road Unit 280.00
I hereby ockrwwledge thct 1 ho reod this opplicotion ond stote thnt gldg. Off. 9/10/85 Tr, pi. 132.00
the informotion is correct o re to comply with oli qppiicabie AP
inn ta t C. f E9an rdinon
State of M esoto S tu C a o O ces. C Parks
Var, Date Copies _
Sipnature of Permitt ?=Z . rj 0
JAD- Q CORP
h Building Permit is issued to: Total
on the expres3 condit?on thol
oti work sholi be done in accordonte with oli npplic4bi tote of Minn sato Statute o
_jd City of Eagan Ordirwnces.
Building Officiol n ?- -
,_ _ ?
J
NOTE:
1985 B()ILDING PERMIT APPLICATION - CITY OF EAGAN
ALL CON?RAC20RS MUST BE LICENSED WITH THE CIT7C OF EAGAN
COHMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL
; & STRUCTURAL-PLANS, 1 SET OF
SPECIFICATIONS AND 1 SET OF
' ENERGY CALCULATIONS
?
??,•. P?! P?u! ?cr..?ra
To_Be Used For: n-s=a--t=-'
Site Address 1272 Birch Point
SINGLE FAHZLY DKELLIHGS
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
? ?I ? O CaC?
Valuation: ,
Lot 10 Block 1
Parcel/Sub Forest Ridge
Owner Forest Ridge PartnershiP
_ Address 1020-East 146th St.
City/Zip Code Burnsville, MN 55337
Phone (612) 432-8240
Contractot' JadRon Corporation
Address 1020 East 146th Street
City/Zip Code Burnsville, MN 55337
Phone (612) 432-8240
_ Arch./Engr. James Cooperman & Associates
Address Shelard Tower
City/Zip Code Minneapolis, MN 55426
Phone # (612) 545-0409
Date: August 15, 1985
OFFICE USE ONLY
Erect x Occupancy ? 1,-Z,
Remodel Zoning 0-4
Repair Type of Const 'SZ
Addition # of Stories "L
Move Length 38
Demolish Depth
Int. Impr , Sq Ft Z?,o<
Install
-------------- '
-------------
----
I APPROVALS FEES
Assessments Permit 3 ("e
Water/Sewer Surcharge '36
Police Plan Review 1?3 z
Fire SAC ' S Z?
Engr Water Conn '5.???v,,
Planner
? Water Meter 901
-
j Council Road Unit 2?,
' Bidg Off Treatment P1 132
APC Parks
Variance Copies
TOTAL 71 _77
?
CITY OF EAGAN -
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 12095
PHONE: 454-8100 -
BUILDING PERMIT Receipt # ? 3 ?Z 17
To be used for POOI' Est. Value $20,000 Date JUNE 10 19 8 6
SiteAddress 1272 BIRCH POINT Erect ? Occupancy
Lot 10 Block I Sec/sub. FOREST RIDGE OFRemodel ? Zoning
Parcel No EAGAN Repair ? Type of Const.
. Addition ? No. Stories -
W
Name
FOREST RIDGE 40
PARTNERSHIP Move ? Length
z SAME Demolish ? Depth -2Q.
o Address Int. Impr. ? Sq. Ft.
City Phone Install ?
¢
o
Name
DOLPHIN POOL Approvals Fees
& PATIO
° a Address 3405 NO CTY RD 18 Assessment Permit $14 0. 5 Q
U? c;ty PLYMOUT*hone 5 4 2- 9 0 0 0 Water & Sew.
U ¢
W
W
?Z
u?
gx z
Q W
Police
Name Fire
Address Eng
City Phone
Planner
Council
Surcharge 1" . ""
Plan Review 7 0. 2 5
SAC
Water Conn.
Water Meter
Road Unit-
Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe g?dg. off. 6/5/86 I Tr. PI.
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City f Eagan Ordinances. APC Parks
Var
Signature of Permittee
A Building Permit is issued to: D PHIN POOL & PATIO
all work shall be done in accordance with all appl_Lqabj_e State of Minn sota tat
Date Copies
Total $220'75
on the express condition that
tes and City of Eagan Ordinances.
Building Official
?
1986 BUILDING PERM APPLICATION - CITY OF EAG.AN
NOTE: ALL CONTRACTORS M(JST BE LICENSED iiITH THE CITY OF EAGgN
SINGLE FANIILY DWEI.LINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCtJLATIONS
MITLTIPLE DiiELLINGS - RESIDENTIAL RENTAL DNITS FOR SALE UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVEY - CHECg SiITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMRCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND ?----'1
To Be Used For: WAyaluat
Site Address y?oz
Lot az ro Bloek ?
?
PareellSub LOf-6AEJ7-- )/?
C 110 G -? o ?
Owner /-6iee,5"4"
Address/)-?? ?))eC47)a0,14
City/Zip Code 9GC„Ar ?fZ?
?
..
-
Phone
Contraetor 01 pAr Y? 70( ?i' Gc+i`b
Address Aa.
City/Zip Code MPQ. ,5`-S%)4
Phone -5`41 r:? ' 9400
Arch./Engr.
Address
CitylZip Code
Phone #
.?
Erect ?
Remodel
??ftepair
Addition
Move
Demolish
Int.Impr.
Install
APPROVgLS
Date:
USE
Occupancy
2oning
Type of Const
# of Stories
Length
Depth ?
Sq Ft
FEF..S
Assessments Permit
Water/Sewer Sureharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Couneil Road Unit
Bldg Off Trpatment P1
APC Parks
Varianee Copies
TOTAL
.112?
A9, ZS"
- ??
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHZCH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
CITY OF EAt3AN WATER SERVICE PWJAff
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Z?ing: _ No. of Units:
Owner;
Address:
Site Addrcss:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
`
1 ayree M oomolp with !M Cihr oF Ee9on $urchorge:
Ordimeem Misc. Chorges:
. t
Tota1:
By Dote Paid: `
Dote of Insp.: I^sp•:
' + w A 1 ? ' 1 ? • I • ' • 1 ' ' I6 • JI• • 3I•
' ?1• 7 • • I ' • ? ! • ` ? ' ' ?? + 1 1 1 • •
• , ? ? ???
CITY OF EAGAN
APPLICATION FOR PERMIT SEWEft AND/OR WATER CONNECTION
(Please Print)
1) PROPII2TY ADDRFSS : I L?14
T,F7;AT• DFSCRIPTION:
(Lot Block Subdivision or Tax Pard-61 I?'b. Num-bKr)
IF EXISTING STRL'CTLiRE, DATE OF ORIGINAL BLILDING PERMIT ISSL'ANCE:
PRESENT ZONING/PROPOSID LSE:
(Nbnth Year)
R-1 SINGLE FAMILY
R-2 DL'PLEX ('It,vo Lnits )
R-3 TOWNHOL'SE (Three + LTnits)
R-4 APARZ'NIENT/CONDOMINIL'M
CODM9QtCIAL/RETAIL/OFFICE
IMUSTR.IAL
INSTI'IUTIONAL/GOVII2NNENT
( Units ) --- -
( Lnits)
2) W•.• :?ra7
ADDRESS:
CITY, STATE, ZIP:
PHONE : 5?? - ? lqi?
3 ) • i: ?•
?
v1_1
lst???GC (?-t-b (??'7`eLx`p7t
For City Use
Pltunbers LicensE
. rArE: c t, t ?
AoD?ss: ?r? L C:L 6-1-? f2?
czTY, sTATE, zzP: 8 L/?A)jU??1 e- /?W
PHONE : -6,w4- - 3,1-m MASTER LICENSE
C= Active
C? Expired
C] Not Recor(
Staff Ina.tial
rrArE: ?P-02?2&S?'L?'
ADDxESS: I 0,2A) 5' fL
czTY, STATE, zzP : ????? t ,9/v
PHONE:
a ?• • • ??
5) 0010M,
.
C( CONNECTION TO CITY SEWER ?CONNECTION TO CITY WATER r
Q OTHER (Please Describe) ?
6) 00,11950 $ma •?i
? PLEA.SE HOLD APPROVID PERMZT FOR PICK-L'P BY ONE OF ABOVE
PLEASE MAI APPROVED PERMIT 'PO l, 2, 4, ABiOVE
(Circ e one)
7, • = 0
E A/ W U7lL.
? -
?
/J 3 r) ?7- CLIW 12,O
F O R C I T Y U S E O N L Y ?
PERMIT " ISSUED
7 ?
FLES:
$
$ $ $
$
$
$
$
$
$
$
$
$
$ .
$
.$ ?
e
SE:':L.n. niRMTT (INCL'.:LE JURCH.c1.RCG)
.
WATER PERr'lIT ( INCL'JDE Sli RCHARGE )
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORRTION STOP)
SE:vER TAP `
.,...?GSIT - ?_.
ACCOUNT DFPC)SIT - UTATER
WAC
SP.C
TRliNK WRTER ASSESS.SE;1T
TRlii•1K SEWER ASSESSLIE:iT
LATE?,AL BENEFIT/TRUNK SE::LR
LATERAL BENEFIT/TRUNK t+7ATER
WATER TREATMENT PLANT SURCHARGE
OTHER: -
TOTAL
Ab10L'tiT PAID/RECEIPT #_ ?,?p J'.`j "3
DOES UTZLITY COIVNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A"PERMIT FOR TnTORK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
? NO ENGINEERING DIVISZON. LIST AS A CONDI-
TION.
SUBJECT TO THE FOi•LOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
CASH RECIEIPl"
CITY OF EAGAN
3830 PILOT KNOB ROAb
' EAGAN, MINNESOTA 55122
19
DATE
?
RECPROM
fAMOUNT $
& DOLLARS
+oo
? CASH ? CHECK
--.?.. ...
F O R -? t . .,+'E 4.. . J?'?....'r ,
FUND CODE AMOUNT
1
i ? , ..,? , .. Sf .,-?
Thank You }
s v
White-Payers CoPY
Yellow-Posting Copy
Pink-File CopY
?.__ _