3101 Hwy 5503
9
?
ao9s- - o2:,,
Requebf t ?ate
?/ ? ? S Fire No.
_ h???q/? ugh-in
oughln In peclion Re ui? Inspection Other T
(YOU m call inspector n reatly) ? R¢ady Now ?y}_Will Noti(y Inspedor
? .?
s No Da[a Reetly
I? licensetl contractor 0owner here6y request inspection of above electrical work at:
Job AdAress (Streel. ute No.?
Box r City
J
5 5
D
w
Sedion No. TownsMp Name or . Range No. County -? ?
f
Ocwp t PRINT? Phone No.
rK n `. '
Pawer Suppliar Adtlress
Eledricel Contrac[ r(COmpany Name) Contrnctors License No.
W /,eA'
Mailing Atlar ss (GOniremor r Owner Making Instellallon)
? e'-
ANhori d eture ( onlrac or/Owner 'ng Inst la ton) Phon? r
MINNESOTA STATE BOAqp OF ELECTRICITY
II THIS INSPECTION REOUEST WILL NOT
Griggs-Mitlwey BICg. - poom 5428 II I I I I I) I I I I
I I I I I? II BE ACCEPTED BV THE STATE 60AR0
1821 Universlty Ave., 51. Paul, MN 5510J II UNLESS PROPER INSPECTION FEE IS
Phone(fi12)6C2-OB00 u . . ENCLOSEO.
J1-V ?{3 REQUEST FOR ELECTRICAL INSPECTION ??'? ? ee-o4oaoi-os
/ I 9? See Instmc[ions tor campleling this larm on back ol yellaw copy. {j`
3i?5?? ?
•-? "X" Be/ow Work Covered by This Request
Ne Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Fumace Other Specify)
Farm Air Conditioner
Omer (specify) Contractor's Ramarks:
Compute Mspec[ion Fee 6elow:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool O to 200 Amps 0 to 100 Am s
Transformers Above 200 Amps- Above 100 -Am s
SI ns Inspecmrs Use Ony: TOTAL S" O
trrigation Booms
S ecial Ins ection
AIarMCommunication THIS INSTALLATION MAY 8E ONNECTED IF NOT
Olher Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
th
if
h R°ugh-in Ddte
at t
ced
y
e above inspection has
been made.
,-
OFFICE USE ONLV
This requesl voitl 18 months fmm
5/ tO q RESIDENTIAL BUII.DING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Consfrudion Reauiremenls RemodeVReoair Reaui2ments Office lJse Onlv
3 registered site surveys showing sq, fL of lot sq. ft o( house; and all roofed areas 2 copies of plan CeR ot Survey Recd
(20% maximum lotcoverage allowed); 1 set of Energy Calculations for heated additions Tree Pres Plan Recd
2 copies of plan showing heam & window sizes; poured found design, etc. 1 site survey for additions & decks _ Tree Pres Nof Reqd
1 set of Energy Calcula0ons Addifion - intlicate iton-site sepfic system _ On-site Septic System
3 copies of 7ree Preservation Plan if bt platted after 711193
Rim Joist Defail Opfions seleGion sheet (hldgs with 3 orless units
A
Date S / 1a. / D3 ! ,,.) ? ?
Construction Cost
Site Address ? ? i-s- Unit/Ste #
Description of Work
Multi-Family Bldg _ YX N Fireplace(s) X 0_ 1 _
Property Owner / ft/l?/?-$ ? t F F`- y Telephone #&7) 6,3 7- (p 3el D
Contractor S E`LF
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota SWes-7.670 Cate o I Minnesota Rules 7672
Ene?gy Code CatBgOry , Residen - o Worksheet • New Energy Code Worksheet
(dsubmissiontype) Submittlveerl?n Su6mitted
• Enevelo.w,,Cralculati ns utlr?f"i tl
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
f43?s-b
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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 witl be in accordance with the approved plan in the case of work which requires a review and
appXDY,al of plans. A n i
? 2 z003 ?
? Telephone #(
l1*.14/+s P- .r rF i= Ej -Imh4c,Q,4-
Applicant's Printed Name I ApplicanYs Signature
0.
A 800 AUDITOR'S SUBDIVISION #38
33300 EFT
41900 HILLDEER
HIGHWAY 55 (PAGE 2 OF 2)
(SEE DODD ROAA ALSO)
2950-2980 MAY BE ADDRESSED OFF DODD ROAD OR HWY. 55
3101 10 03800 081 10
3211 1 O 41900 01201 (SINGLE FAMILY)
3225 1003800 07010 (SINGLHFAMILY)
3245 10 03800 090 10
090 08
3255 10 03800 030 10
3265 10 03800 04010
3285 10 03800 020 10 <° ^)
3295 10 03500 010 10 (° °)
3315 10 32000 071 00 (° ^)
3325 10 33300 010 Ol (° )
3345 10 03800 010 03
3350 10 03800 080 02 ?^ ^)
3366 10 03800 030 02
3400 10 03800 070 02
3401 10 03800 020 03 ()
3411 LO (STORM SEWBR METER)
3413 (STORM SEWSR LIFT STATION)
3415 10 01200 010 06
(" ")
3430 10 01200 090 02 (" ")
3432 10 01200 080 02
3434 10 01200 070 02 (" ")
21
Permit #:
Receipt Date:
CITY OF EAGAN
2007 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES
EXISTING RESIHDEN7['Il[$]L PROPERTY
Address 31C)i OoW?tv 5,Li
?
Property Owner 1 w.
Telephone # (v71- q f? `( ' '?? 7 7
302.
Plumber y ?- ?,ja-L'sss
Date of Inquiry
ContactName roo„ u
Sewer
OFFICE USE ONLY
g? PRV required
/City /?o County R-O-W Permit
Water
4" Sewer Se ' e $ 691.00 1" Water Serv?se $ 772.00
Sewer laYeral char @S2830/ff Water lateral cha?rge @
Sewer mmk @$1,15 nnection Water h-unk @$1,2b0l?
V
City SAC 100.00 Water supply & storage 1.070.00
MCES SAC 1 675.00 Receipt # ,
Receipt # ate
Sepric abandonmen 50.00
t plant 660.00
Treahnen
Permit Fee 50.00
Permit Fee ?'' 50.00 State Surcharge?, .50
State SurCh<y'-ge .50 Plumbing pet?it required - water
/'' meter To b?.e'cquired with plbg permii ?
$ \I I'jYal $ ?
,?
Sewer and Water
,e?v?-£aacice ?a--69i?A0
Sewer lateral charge @$28.30/ff ( II?{t=) 3 2-3.1
Water lateral charge @ $28.60/ff ?l+t+F') _3 37`i. -O
n
city sAC 100.00 x
MCES SAC 1.675.00 tL
Receipt # Date
Water supply & storage 1.070.00
Receipt # , Date
Treatment plant 660.00
Septic abandonment 50.00 4
Permit Fee 100.00 R
State Surcharge .50 ;
Total $ I'q.ZU
Plumbing permit required
Water metex to be acquired with plbg pernnt
cc: Carolyn Krech, Finance Depar[ment
2007 RESIDENTIAL PLUMBING PERnniT aPPUCarioN
-D 3 CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please com lete for modifications to existin residential dwellin s.
Date 4I / 1 n / C) ?
t
Site Street Address G Unit #
PropertyOwner Telephone# ( ) I
Contractor ?l"? i52 kS 7rt L Telephone #(So7 ) 7 L/
Address c2o a S?A? lvlq(, .SCity LoxS4-,(e- State!4?V ZipS.SU`{(,
The Applicant is: _ Owner & Occupant Licensed Plumbing Contractor
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes Countyfee
$ 100.00
Per as-built $ 10.00
Fire Repair (replace burned out fixtures, etc.) $ 90.00
This fee a plies when extensive lum6in re airs are made to a buildin .
Alterations to existing dwelling $ 50.00
_ Add plumbing fixtures to main level lower level. This fee includes
installation of a water softener and/or water heater at the same time. !f you are
installing onlv a water softener and/or water heater, do not complete this section;
move to the next section and place a checkmark next to the appliance(s) you are
installing.
Septic System Abandonment
?water Turnaround (add $136.00 if a 5/8" meter is required) ?
4? l. .UU
Other:
Water Softener _ Water Heater $ 15.00
_ new _ replacement
Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
State 5urcharge $ .50
Total $
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the
work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I
understand this is noi a permit, but only an application for a permit, work is not to start ' out a permit and work will be in
accord-apce ith the approved plan in the event a plan is required tCviewed,a proved
/l-1 JM 15P?\ r
p icanYs Printed Name ApplicanYs Signature
V? p 4
Pe?mit t7!s ` A• .? I U,7+ Receipt Date:
?7(,.SV
36.
CITY OF EAGAN
2007 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGESq•
EXISTING $2ESII?ENTYAII., PROPERTY
Address ?10/ t-A'yXWaX 5-5
Property Owner ! p t? y r r?/2y
Telephone # & '?7/ - ?j3 /j - a527 `l
Plumber 5H-,45,2/-- '??wm/?yy
Date of Inquiry 11- 3-0-7
ContactName Sewer
OFFICE USE ONLY
,ffo_ PRV required
Ye5 City & County R-O-W Permit
Water
4" Sewer Se ce 691.00 "
Sewer lateral ch e@$28.30/ff Water lateral charge @$28.60/ff ii Y3 C{: 3??y, --° ,,,?
Sewer trunk @$1, /connecrion
City SAC 100.00 Water supply & storage 1.070.00
MCES SAC 1,675.00 Receipt # , Date
Receipt # , D Treahnent plant 660.00
Sepric abandonment 50.00 Permit Fee 50.00
Permit Fee 50.00 State Surcharge .50
State Surcharge .50 Plumbing permit xequired - water
meter to be acquixed with p16g permit
'r g Total $ 5 575-.3'
\ Sewer and Water ?
4" Sewer ce $ 691.00
1" Water Servi 772.00
Sewer lateral charg $2830/£f
Water lateral charge (0, 28.60/ff
Sewer trunk @ $1,150/co ection
Water trunk @ $1,200/conne on
City SAC 100.00
MCES SAC 1,675.00
Receipt # , Dat
Water supply & storage 1,070.00
Receipt # ? ate
Treatment plant 660.00
Sepric abandonmen 50.00
Permit Fee f 100.00
State Surchar¢e .50
Total
ing permit required
meter to be acquired with plbg pernvt
cc: Carolyn Krech, Finance Department
v
414', - pl,,,3ne r a? eci ?PC?.
-?o ho 012 -C44
0.-4- s +; wt° .
Z1'1 a-0 lb"?, ?T P1C GPCi?Ps
-kv s 1e_ %n p+a S e va e r
-?"hese 4ees o',Vr t
c s4f*cx-i a f
SQwar hA k?
?
Y"
WAIVER OF HEARING NO 719
SPECIAL ASSESSMENT AUTHORIZATION FOR UNPAID PERMIT FEES
I/We hereby request and authorize the City of Eagan, MN (Dakota Counry) to assess the
following described property owned by me/us:
EAST 118.25 FT OF THAT PT OF LOT 10 LYING IN NW 1/4 OF NW 1/4 OF SECTION 12,
TOWNSHII' 27, RANGE 23
For the unpaid permit fees:
ITEM QUANTITY RATE _ AMOUNT
Permit Charges 1 $5,155.30 $5,155.30
(Water Connection)
TOTAL: $5,155.30
to be spread for a term of 10 years at an annual interest xate of 5.5°lo against any
remaining unpaid balances.
You may pay any portion of these special assessments within thirty (30) days of signing
the Waiver without interest at the Eagan Municipal Center. If you pay after the thirty
(30) day period, interest will be charged from the signing date to December 315L of the
current year.
The undersigned, for themselves, their heirs, executors, administrators, successors and
assigns, hereby consent to the assessment of these unpaid permit fees, and further, hereby
waive notice of any and all hearings necessazy, and waive objections to any technical
defects in any proceedings related to these assessments, and fiurther waive the right to
object to or appeal from these assessments made pursuant to this agxeement.
Dated: "o ?/?f'/?
Fee Own
Notary ihTU
? Fee wn
' ' . PATRICIA J. fITZPATRICK
%? •Notary Public-Minnesota
My Commission Ezpires Jen 37, 2010
Thomas
Kathleen Diffley
???1YED
APR o 9 2041
ikGNVA
t%GINEER NG 0EPARTME%1
9528917000
DEC-01-2008(MON) 17:08 Dakota County PD0 (FRK)9528917000 P.001/001
C520 ? c O ? N?r
WATER RESOl1RCE5 OFFIGE
GROUNDWATER PRO7ECTWN SECTION
14955 Gaiaxie Avenue • Applc Valley, MN 55124
952.891.7557. • Fax 952.881.7568 • www.co.dakota.mn.us
MUNICIPAL MOTIGE OF WELl. SEAL.ING PERMIT APPLICATI(]t3
DATE: December 1, 2008
TO: Tom ColUert/\Vayne Schwanz (EN)
RE: Wcll Pcrmit #: 0844267902
1VTunicipality: Eagan
Fax#: (651) 675-5694
Wcli 1ype: Domestic
Water T.tesources 5pccialist: I.uchrs
The Dalcota County Water Resources Office has received fhe foliowing pemut application for the well describtd. If
you require f'urther review of dhc applicaYion or if you have any questians or concerns about it, contact the Water
Resourcc Spccialist listed above or our office at (952) 891-7557. If there is no response ftom your office within 24
14OURS (exclvding weekends and holidays), wz will ussume that you have no objections to the issuance of the
permit. Plcase note that permit issuance is always conditioned on the pemut applicant's observance of and
compiiance with uil applicablc state, counry, and municipal laws and cocles.
Welt Contractor:
DAte Application Rcccivcd:
Anticipated Drilling Dafc:
Anticipntecl Gz'oating Date:
Propcrty Owner;
Well Owner
WELG i,pCAT[oiV•
Kimmes-$aucr We11 JJrilling
11J25/2008
Timc:
Time:
Tom Difflcy
"1'om Difney
PLS Coordinates: 1l4, SE 1/4, NW 114, NW 1/4, Sec 12 Town 027 IZange 23
Street Address: r3I01 HiF;hway 55 ?
PIN Nnmbcr. '100384008110
WF.T.i. TNFORMATION:
Diamcter:
Casing Dcpth:
Total Depth:
Static Watcr Lcvcl:
Aquifer:
CbNIlvIENTS:
of EAGAN
, -:
?
. '..... ? __.... :..?, _
Legend
tLL
A Highligh@d Feature
Municipal Boundary
, Condo Points
SVeets
? Lakes
? Parks
? Parcels
Property Owner Assessing Sales
PIN: 100380008110 PID: 100380008110 YearOUilt: 1890 Sal¢ Year: 1995
House#: 3101 Full Name: THOMAS & KATHLEEN DIPFLEY land Value: 110100 Sale Monih: ID
Street: HIGHWAV 55 Address 1: 19 HILL FARM aR Building Value: 7000 Sale Value: 9400D
ppy; AOtlress 2: ToWI Value: 117100 Sale Tax: 0
ZiP CiryST: SAINTPAULMNSS3P-2012 Ne[Tax: 865.52
fAde; 5512ID000 Total Tau: 865.52
Lot: 10
Zoning
PIaC AIIDITORS SU80[VISION N038
E 118.25 FT OF THAT PT OF LOT 10 Zone Cnde [SqFt]: GB
Legal: LttNG Irv NW 1/4 OF NW 1/9 OF SEC 12- Zone Des: General Business
27'23 LandUSe Code: RC
LandUSe Desc: Retall Cqmmercial
N ????w [E?
MAY 0 7 2009
,
I Fat _ Off,ice;Use _ _
I
I (? ?
? Pertnrt #: ? O I
? Permit Fee: / ?0• S L' ?
I
I
? Date Received: ?
I ?
? StaH: ?
-------------
e" I If 't 2008 MECHANICAL PERMIT APPLICATION
Date: _(hC ?$, aCOQ Site Address: 31 O 1 rj j
Tenant:
Suite #:
RESIDENT/OWNER Name: I'e1gvt-& o e ?ce• iCKe.el OPhone: bSI - ySU' p"toZ6s
Address / City / Zip: 310 t C??+s S 5 C? O?,yl /'Y1 N SS I a j
CONTRACTOR Name: CENTERPOINT ENERGY License #:
Address:9320 EYERGREEN BLYD SUITE B
City: COON RAPIDS State: MN zip: 55433
Phone: 763-757-6202 Contact Person: JOANN ZINKEN
TYPEOFWORK -)C New -Replacement _Additional _Alteration _Demolition
Description of work: a..? (-t) *4 D?.????@SS RJ e a.Y,d a4on 'b L.et`
NOTE: Both7oot mounted and ground mounted mechanica/ equipment is required to -
6e screened by Cify Code.' Please contact the Poleohartica!lnspector or one of the
Planrier§ for intormation od ermifted screenin' methods. -'
PERMIT TYPE RESlDENT?AL COMMERCIAL
Furnace _ New Construction _ Interior Improvement
?AirConditioner(-2? _InStdllPiping _Ptocessed
Air Exchanger
- _ Gas E#erior HVAC Unit
HVAC units must be screened
_ Heat Pump Under / Above ground Tank L Install /_ Remove)
Other " When installing/removing tank(s), call for inspection by Fre
Marshal and Plumbin Ins ector
RESlDENTfAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fil'@ r0pair (replace bumed out appliances, ductwork, etc.) (includes $.50 State Surcharge)
$ SU,SO TOTALFEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x i°k
$50.50 Minimum (includes State Surcharge)
Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Pennit Fee is >$1,000, surcharge increases by $.50 for each =$ Siate SulchBrge
$7,000 Permit Fee (i.e. a$1,001-$2,000 Permit Fee requires a$1.00 surcharge).
$ TOTALFEE
--r a?--?v= 11-a1 <',,, ?,,,.1111aU.11 l> ooIIIpIeLe eno eccurace; mat me worK van oe in cornormance wim me orainances and codes or me ciry or tagan; mat
I understand this is not a permit, but oniy an application for a permit, and work is not to start witho?t a permit; that the work will b in accortlapce with the approved
plan in the case of work which requires a review and approval of plans. ! t //
x JOANN ZINKEN
ApplicanYS-Printed Name
Signature //
Aid.
POR OFFICE USE /I#eviewed By: Date ?
Required Inspections: Under Ground Rough In _Air Test Gas Service Test In-floor Heat Fnal
For Office Use
Permit
City of Ea~d~ ,
Permit Fee:
3830 Pilot Knob Road
Date Received: I
Eagan MN 55122
Phone: (651) 675-5675 i
Fax: (651) 675-5694 i staff: - - - -
2009 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES
EXISTING RESIDENTIAL PROPERTY
r°; 1
Address: OFFICE USE ONLY
INA
Property Owner:
ilk&
Telephone PRV required
Plumber:
City _County R-O-W Permit
Date of Inquiry:
Contact Name:
SEWER WATER
Sewer Service -O - Water Service
Sewer lateral charge~31'~'~;n IIf~ firF'. 3 " ° Water la ral charge
Sewer trunk'- 9r~,~, y Water trun
City SAC $100.00- Water supply age $ 1,150.00
MCES SAC $2,000.00- Receipt te'°
Treatment Plant $ 735.00
Se tic abandonment Dc ol'7 ! $-50:A0 Permit Fee $ 50.00
Permit Fee $50.001- State Surcharge $ 0.50
State Surcharge $ 0.50 *Plumbing PP rmit Required - water meter to be
acquire with building permit
TOTAL:TOTAL:
SEWER & WATER
Sewer Service
Water Se ' e _
Sewer lateral arge @ $28.30/ff
Water lateral ch e @ $28.60M
Sewer trunk @ $1, O/connectioR-'"
Water trunk @ $1,200 nnection
City SAC $100.00
MCES SAC $ 2,000.00
Receipt # `Date
Water supply & storage $1,150.00
Receipt # Date
Treatment pl~rt $ 735.00
Septic abay~triment $ 50.00
Permit F 100.00
State S rcharge $ 10.50
"Plumbin Permit Required - water meter to be
acquired With building permit
TOTAL:
Use BLUE or BLACK Ink
l /
t
MY of EaRdIl - ; Permit:
I
Permit Fee: f5Q 1
3830 Pilot Knob Road
Eagan MN 55122rl 1 Date Received: ;
Phone: 651 675-567 rh ; t
Fax: (651) 67548,94 r J I Staff- - - - - t
460 d-1;M C-61& cce4
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION `
Date: t cl Site Address: . O _ t ~g (,t_,10Ly LS S °
Tenant n W lam` 7""' Sups #I:
4.a GS
RESIDENT IOWNER Name: ~n h ut I. IS T-Te~e:U,,.SjeW Le!: CCPhone
:
Address / city/ zip: 3 a lbu Rpa c.(
CONTRACTOR Name: 34 e C U¢ f! License #
Address:
City: ~rn.5 ct State: -/W/0 Zip: SAS d
Phone: S-O S$-(o ContactPerson: .SQ11 rnd
TYPE OF WORK New Replacement _ Repair _ Rebuild 4<odify Space w„ Work in R.O.W.
Desert on of work:
PERMIT TYPE RESIDENTIAL
Water Heater Water Softener
Lawn Irrigation Add Plumbing Fixtures
RPZ / PVB) Main Lower Level)
Septic system Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$60.60 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (inches $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turtaround* (includes $.50 State Surcharge)
'Water Turnaround (add $165.00 if a 50 meter is required)
$100.50 Septic System Now ($10.00 per as built) (includes County free and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $
CAL k IIEF_OIRE YQU DIG,. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.ora
I hereby acknowledge that this information is complete and accurate; that the work will be in confomrance with the ordinances and codes of the Cky 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 M the case of woic which requires a review and approval of plans.
x Sr "tt st mon t; -
Applicants PrInlAl Name Applicant's S! re
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-in -__Air Test -Gas Test ,_Yinal
T/T'd t769SSZ9TS9:01 :Wod-d d60:60 6002-6T-100
9528917000
OCT-15-2009(THU) 09:07 Dakota County PDD (FAX)9528917000 P.001/001
1
C a u H r r
k~
WATER RESOURCES OFFICE
GROUNDWATER PROTECTION SECTION
14955 Galaxie Avenue - Apple Valley, MN 55124
952.891.7557 - Fax 952.891.7588 - www.co.dakota.mmus
MUNICIPAL NOTICE OF WELL SEALING PERMIT APPLICATION
i DATE: October 14, 2009
TO: Tom Colbert/Wayne Schwan (EM) Fax (651) 675-5694
i
4i
` ID!:: Well Permit 09-I-1282729 Well Type: Domestic
Municipality: Eagan Water Resources Specialist: Olsen
The Dakota County Water Resources Office has received the following permit application for the well described. If
you require further review of the application or if you have any questions or concerns about it, contact the Water
Resource Specialist listed above or our office at (952) $91-7557. If there is no response from your office within 24
HOURS (excluding weekends and holidays), we will assume that you have no objections to the issuance of the
permit. Please note that permit issuance is always conditioned on the permit applicant's observance of and
compliance with all applicable state, county, and municipal laws and codes.
Well Contractor: Don Stodola Well Drilling Co.
z
Date Application Received: 10/13/2009
I Anticipated Drilling Date: Time:
Anticipated Grouting Date: Time:
Property Owner. Robert E Ferguson
j Well Owner: Robert Ferguson
a
1
WELL LOCATION:
PLS Coordin tes: / 4, NC 114, SE 114, Sec 20 Town 027 Range 23
Strect Address: 1720 Taconite TRL
um r: 100200006
WELL YNFORMATION.
d
Diumeter:
1 Casing Depth:
Total Depth:..
Static Water Level:
Aquifer:
COMMENTS:
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA089088
Eagan, MN 55122 . Date Issued: 05/08/2009
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 3101 Hwy 55
Lot: 000 Block: 010 Addition: Auditors Subdivision 38
PID 10-03800-081-10
Use
Description:
Sub Type: e-Windows/Doors Construction Type:
Work Type: Windows/Doors-New/Replacement
Description: House
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: hnprovements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: -Applicant - Owner:
Flannery Construction Television Service Labs, Inc
1375 St. Anthony Avenue 3240 Dodd Rd
St. Paul MN 55104 Eagan MN 55121
(651) 225-1105
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