3315 Hwy 55.. ^i . ?"+?3?-.-..•. ?. _.__-?. ""-?...-'.r .. .'_".? ?-r .
CASH RECEIPT ?
CITY -QF f AGAN
? 3830 PILOT KNQB ROAD
EAGAN, MINNESOTA 55122 '
' oaTe
. ? -
AECEiveo r /t
FRO+a e-, ?'?'7 ?•
A
AMOUNT
FUND I OBJECT I I I AMOUNT
Thank You
,
BY
White-Payers Copy ;
Yellow--Posting CopX
Pink-File Copy
. .. . ... . wl.uaer.
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CITY OF EAGAN
3795 Pilot Knob Road Eagan, MN 55122 N2 4346
PHONE: 45461 QG
BUILDING PERMIT ,?o.,...? Receipt # n250
,
To be usod for Swiltlmisg P4o1 Do te 19
Site Address i
hwar ; ` Erect 0 Occuponcy -
v
Lot Block Sec/Sub. j=?qrvpy Adrii7_ Alter p Zoning
Parcel # Repair ? Fire Zone
Enlorge ? Type of Const.
W Nome `t= : L Move ? #? Stories
3
Address -
Demolish
?
Front ft.
?
Cit ;As-nn Phone 454-2425
Grade
? -
DePth it.
z p Name _
?,
o? Address
V
Nome _
Address
AssessmenY -
Water & Sew.
Pol ite
Fire
Eng.
Planner
Council
Fees
_
Permit 18.00
Surchorge
Plon check _
SAC
Water Conn.
Woter Meter
I hereby acknowledge that I have reod this application ond state that gldg. Off.
the information is correct and agree to comply with all opplicobte APC Total ???. r'?3
State of Minnesoto 5tntutes and City of Eagon Ordinonces. -
Signature of Permittee ?--LF y?--?--- ,
A Building Permit is issued to: ? t. CIGiX VAllY2Y p001 S _ on the express condition that
oll work shall be done in occordonce with all opplicable State of Minnesota Statutes and City of Eacan Ordinonces.
St.
Building Official
r«?.M # Dae. I.w.d r.r.kr..
Plumbing
Mechanical
INSPECTIONS DATE INSP.
Rouph-In
Finol
Footings Date Infp. Oate Itap.
Foundation Plumbing
Frome/ins. MecFanlcal
Final
Remorks:
CITY OF EAGAN
3795 Pilot Knob Rood
f Eagan, Minnesota 55122
Phone: 454-8100
PERMIT
.i . . .. _ '7[?
Dare: Site Address;
t
L
o
, . . "l, . -r?: .. . , .. .
Name
c Address
3
O
City Phone:
Name
.
?
P Address
e
0
v
City _ Phone:
This Permit is issued on the express condition Yhot all work shall be
Minnesoto Statutes and City of Eogan Ordinances.
C?ISTIC?1? A?R? ?
No.
1609
Receipt No.: ?
Single I
Residential
Multi Res., Comm.Jlnd. 4
New/Alter./Repoir
Cost of Installation
Permit Fee
5urcharge
Tota I
done in occordance with all applicoble State of
Building Official
1?/s???d
CONTRACT PRICE:
Site Address -' 757
?'
Lot ?'' ' Block -
? Name :
? Address
c City _
PERMIT #
PLUMBING PERMIT RECEIPT #
CITY dF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: -
Phone
Name 1 rUrSrI .?c
?
3 Address wy.
-
p City ? Phone
FEES
COMM/IND FEE - 1ai6 OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
I SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAI
Water Closet - $3.00 $
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Ki!chen Sink - $3.00
Urinal/Bidet-$,3.00
?
Laundry Tray - $3,00
Floor Drains - $1.56\ ?
Water Heater - $1.50
?
?
Whirlpool - $3.00 , \
Gas Piping Outlets - $1.50\
(MINIMUIy{ = 1 PER PERN?FT)
Softener - $5.00 ?
Well - 310.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE:
4
srare s/c:
GRAND TOTAL:
CITY OF EAGAN
3830 PIl
t K
d
b R Permit No:
?03 13 Date: -??
5i
?
o
no
oa MetPr No: ze:
'
P.O. Box 21199 Reader Kr?: 0 S?? 3 0'? ? 5 pate:
'Ea9an, MN 55121
Truesdale
Conn, Chg: Zoning:
Acct. Dep: No. of Units:
Permit Fee: i-
Surcharge: 1 agree 1o comply with the City oi
Tr. Plant Ordinances.
Meter. -?Y-. ?f w . ?-. - - a. IK _ C Il`l '
:.
CITY OF EAGAN Permit IVo: 9726 Date: 6-2 9
3830 Pllot Knob Road Meter lyo: Size:
P.O. Box 21199 Readbr Mov Oate:
Eagan, MN 55121 Owner. `?ehn TrueRC?etB
? z 5
Site Address:? 4' i^.7-2-Y 55 lt? 32400 . 0
1 • - --
Conn. Chg: 550.00pd Zoning:
Acct. Dep: 15•00pd No. of Units:
Permit Fee: 10.000
Surcharge: • 50pd 1 agree to comply with the City ol
Tr. Planfi 204-6p d Ordinances.
Meter. 67-1QQ;d
Misc : By
WATER SERYICE PERMIT
? CITY OF EAGAN Permit Nq: 1 v-77 2 Date: 6-'29'88
3830 Plipt Knob Road B/P No: _ ?STT* { Date:
P.O. 139X21199
k Eagan, MN 55121
f .. 50:1i1 7'rl1C.8dale -- ?
CC: Zoning. RZ
,
Chg: ?'?'? • Q?'T"' No, of Units: L
:. Dep: 15. OC?.-t
1 agree to comply with the City of Eagan
nit Fee:
.?... _..,.
?,.:? Ordinances.
By
SEWER SERVICE PERMIT
CITY OF EAGAN Remarks
Additirn_.HARVE'.'Y ADDIT7'ON #l Lor 7?^Blk ? Parcel 10 77n?0 071 nn
Owner ?){, f) ; t ,; .'' ` &'U ('-dC{ l C Street ?9 Hwv• #55 State -Ea=.@_ML59122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNKQ 1970
. 5.0 2
iE SEWER LATERAL& S 1972 26 -
WATERMAIN
WATER LATERAL 1972
WATER AREA
STOFiM SEW TRK 1984 37.40 r15 561.00 C008496 7-12-83
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
BLDG. PERMIT NO.
01-3210 Bldg. Permit
01•34?2 Plan Check
01-3445 Surch./Adm. Is
01-3446 SAC/Adm. .5 .?d
01-2155 Surcharge
r
75-3860
Road Unit
2o-zi7s sac _5-)
20-3865 Water Conn. 5 7G o o
20-3868 Water Trmt. T? r? U
20-3716 Water Meter 7 OC?
20-2252 Acct. Dep. C7
20-3713
20-3743 Water Permit
Sewer Permit
793866
28-3855 Sewer Conn.
Park Ded.
o n
TOTAL
CITY OF EAGAN
., _ '3795 Pilot Knob Road Eagan, MN 55122 N2 4346
PHONE: 454-8700
BUILDING PERMIT APPLICATION Sa-?-?+ ReceiPt #
To be uma for SwimminQ Pool Dare .I??*+P b , 1977
_
Site Address?? ??ighwa,._55 -- Erect n Occupancy
Lot-_Z_ Block Sec/Sub. HgrvTev Addn_ Alter ? Zoning
Parcel # - Repair ? Fire Zone
Enlarge ? Type of Const.
w Name Jack Truesdale Move ? # Stories
3 Address-'3315 H47y. 55 Demolish ? Front ft.
°
Cit
Phone 654-2425
Grade ?
Depth ft.
p N St. CIO3X V811eV P0013 APProvals Fees _
p ame
?? Address 13481 No. 60th St,
Name _
Address
Assessment -
Water & $ew.
Police -
Fire
Eng.
Plonner _
Council _
I hereby acknowledge that I have read this applicotion and state that gldg. O4f. -
the infortnotion is correct and agree to comply with oll opplicable
Stat of Minnesoto Statutes and Cit gf, Eo an Ordinonces APC
Permit ltl_UU
Surcharge 2.50
Plan check
SAC
Woter Conn. __
Water Meter
e ?? I Totel 20.50
Signature of Permitf
A Building Permit is issued to: $t Cro3x V Llf POOLS on the express condition that
oll work sholl be done in ccordance ith oll pplicoble Stote of Minnesoto Statutes ond City of Eagan Ordinances.
Building Officiol
EAGAN TOWN S H I P No 524
i _ BUILDING PERIMIT
OwnBf )_,J?S?!!CE'?....- - -..t, - -? - - _--- . _ Ea9an Township .
---. .....- "'-
>T /? `
Addreas (preseni) ..q.. . _. . __ ,? _... /..I-i, . . / Town Hall
/ ---`------- ---'
Builder ........__....?".L<,G6 e`...,............_.-°---------------°----....--------- ?+? %
DaYe .`'i"....s?i?_??...?..........._.
Address _--------.....__....------_..-----------------._..-------°°--------------
Siories To Be Used For Froni Dep1h Heighi Es3. Cos! Permi! Fee Remarks
? ???'?.? ? ?? a? ? I
?.???? f?? ??I I
???. G?,?.?
LOCATION
._ Sfreei, R?tlad' or oiher Descsip39on of Locaf9on I Lo! I Elock I Yiddifion or Tiac1
This permiY dces noY aukhorise ik? se of sireeis, roads, alleys or sidewalks nor does ii give !he ce4nex ox his agen!
ihe righ! !o creaie any siluation whi is a nuisance or which presenis a hazard io 2he heallh, safeiy, convenience and
general welfare io anyone in ihe communiiy.
THIS PERMIT MUST KEPT ON T E PREMISE WFIILE THE WOAK IS IN PROG E5?5/ -
This is io certify. Yha -___?_..._..._ .,d? ?? P
.{
? ?:2[`___.._.._.. has permESSion io erec! a..4??tfll?dL!__........__'_"'___._._____.u oa
!he a6ove descxibed premise ]ec fo ihe pxovisions of !he Buildin Ordi ce for - wnship adopied April 11.
19b5. '
.___'_.'.__.____.._..__._.....__.___?__ ..................__.._____ $er __.. .. ?
_ . _.__.,.___ __?_ . _ .._g._._._P__...___"..._'._.._'.._......
Chairman of Town Board ? ldin Ina ecior
' 2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construclion Reauirements
.? 3 registered site surveys showing sq. ft. ot lot, sq. H. of house; and all roofed areas
(20%maximumlotmverageallowed)
YSoils Report if proposed 6uilding is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
M1 set of Energy Calculatians
3`upies of Tree Preservalion Plan'rf lot platted afler 71l93
Rim Joist Detail Options selectlon sheet (huildings with 3 or less unifs)
Minnegasco mechanical ventila6on torm
RemodeVRepair Reauiremenls
2 copies of pian showing footings, beams, joisis
1 set of Energy Calculations for heated additions
1 site survey for additions & decks
Addifion - indicate i/on-sife septic sysfem
Plans are considered public information unless vou state they are trade secret and the reason.
Date ? l o? 8
/ D 7 u?
Construction Cos1
5ite adaress 33 /S H GV ?/ S$ Uniuste #
Description of Work r-_ ?"? /J /?
/C CJ ?CC/LiJU T
Multi-Family Bldg _ Y _ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner / C/ GA, ?q/c'r,( /JE64S[= N Telephone # ?5"/ ) 41_5 21
Contractor ?C f-p/LT KOoy/nC ?G
Address City _
State Zip 5?'jJCY 7 Telephone # QS ? 0 F(r -F
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cate2orv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventllation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted 5ubmitted
• Energy Envelope Calculations Submitted
In the last 12 monihs, has the City of Eagan issued a permit for a similar plan based on a master plan8
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
Telephone # (
DtGCB U8@:.OniV
Cert ofSuneyRe? :`YN
Sails Repod:
TreePres?,Ptao-€tecd Y ?fy
TreePresReqwred; :=Y _N
OnsiteSePticSYsfem _Y `N
I hereby apply for a Residential Building Permit and acknowledge thaYthe information is complete and accurate;
that the work will be in conforniance 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 will be in accardance with the approved plan in the case of wark which requires a review and
approval of plans.
ApplicanYs Printed Name ?
Applicant's Signa ure
?
13UT_'T'?IiIG I'iRMIT 2,PPLTCe'l71C'7
i(_T ! -_.. Ft:ACN PLi3 `j 3'Z.(-)U U 11iJDIT1017 ?r v -?771?T.ZPiJ ._..?.?._..?.
P',IdCUL & ST^.^•iOT_.', +:::i11;3E2 li :ii.i?==--all'ED p(W-C.r=,f,_ ??71-00 _..._.?.._....
E'sF,S3 Ge i?:IRC?]L j??) S^ N
e'.:Oi3T:?G O?C.TJ."•+P.1.•iCY ?C-_.SSf)F.ti77i'lLU5,.^tSW?a?, '?-tm?r? C?-_?ao c./
CiC5a_.
C2 '1a-c-K ?-T C-??f-`-i?A(
---
car:r°r?:.=;cTon sL_?..R osx U:F+c_?? y no o?_, f msLEnxorz:. :ao.
a„DRB; s__ 13 ?? rv , 60 -rH ?,-r _ s -T T; , _L-'?2rF?- 4-L ,-?
[v?t.^_? It?cwr?:ix? w;.te plan, buil.ling plans, ani-1 energy calculatio: r5 v':i.th c.his
ai;p l -ir,ai ion
Signed
OFFICE USE
C.A<T.U?ITIOE; ? ?? ?1 ?)
, • ?? ? 1????
ria4 s ^i???.Z?
5'l:C
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edZay'LR
?i3:i3:D'SSdG F?:F.r:3'9! 1"::3
i'I,S1Y7 Cxi<C;: ?'EE
nAR,. D-77i!':°1'CI014 FE$
05.'i>^R
xoTali*
.
Ar_dnOa.aT.s o
C= BUSLDrNG DEPT. POLICE DEPT
T.S.iTF:R F si?t:'I'R Di3PT. FI?L DrPT
PAI2K DZ`-'T.
APFLICATION f-'OR PERMIT
SEWER ANQ/OR WATER CONNECTION
,
.*? NOTE: PAYMRIf OF FEL+ AT TiME OF
?
* AYPLICATION DOFS NCIP CON- .?,
SfI7LT1E APPRGVAI, OF PIItFIIT.
•
* INCPPITTCN OF SEVM APD/OR WA7ER
t.
? IN51'NdATIOE15 WIIL [IX71' BE SCfaUI.FD ?
? [R7liL PE[7DIIT HAS BEE2i IiPPAWID. ?
*iStf}441#lffYtlf#i*liiSStff?l4?ltff*fi
oF CC9gaf9
(PLEASE PRINT
11 PROPII2TY ADDRES.S: Gy'A Y.?`.? /d/v r?. 1?F7 N- J-2/
T.FY:AT• DESCRIPTION; 071
. t??J . . .
or
IF EXISTING STRC'C7Y7RE, DATE OF ORIGINAL BUILDING PL,.f' 2N1iT ISSOANCE:
Nlont Year
PRESENT ZONING/PROPOSID USE:
Q CONA142CIALjRETAIL/OFFICE EgtR-1 SI[QGLE FAMILY
Q INDUSTRIAL ? R-2 DUPLEX (3WO Ljnits)
Q INSTITUTIONAL/GOVERNMENT ? R-3 TOWNHOUSE (Three + Linits) ( Lnits)
Q R-4 APARTMENT/CONDOMINIUM ( Units)
.
2) NAME
ADDRFSS.
CITY, STATE, ZIP: --2
PHONE:
For City Use
3) ?:?• NAME: ,,?yc?a-r?G- ' Pl erums License:
Active
ADDRESS: , ?. Fxpired
czTY, STATE, ziP: 6-10- 3 i? Not recordec
PHONE: MASTEft LICENSE # St Ia n?'itial
4)
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
5) s (1 , ?: 'M
,` CONNECTION 'IC) CITY SEWER t!JCONNECTION TO CITY WATEEt M QTEIEF2
6)
*****xx*???*??*******?**:t**+t**,r**?***?*+***+*******x**«******************,t*t****?aa*************?y
?
* THE GOLD COPY OF T[E PERNIIT WILL BE SENP DIRDCIY,Y TO PUBLIC WORKS TO FACILITATE MEiM PICK-UP. w
* PI,EAiE ALSAW TWO WDRKING DAYS f'OR PROCESSING. SOMEONE F7tOM TfIE CITY WILL CONPAGT YOL IF THERE y
* ARE ANY PROBLENIS. e
??**?,r**?**,r***??**?*?**,t?*?**?***+**+*??r,*******?***+***,r*+**?,r?*****?**+???**?*?,r**????*??*??x***,
FOR CITY USE ONLY PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ 4P '5Z7 $ SEWER PERMIT (INCLUDE SURCHARGE)
$ ?d S--o $ WATER PERMIT (INCLUDE SURCHARGE)
$ $ WATER METER/COPPERHORN/OUTSIDE READER.
$ $ WATER TAP (INCLf!DE CORPORATION STOP)
$ $ SEWER TAP
$ ?5 C? $ ACCOUNT DEPOSIT - SEWER
$ $ ACCODNT DEPOSIT - WATER
s $ WAC
$ CsS_? ' ?r? $ SAC
$ $ TRCNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRLNK SEWER
$ $ LATERAL BENEFIT/TRONK WATER
$ $ WATER TREATMENT PLANT SDR
CH
ARGE
$ !a J ` $ /
?
OTHER: g-ge---»"tf-?-.-?,
S f5 E?57' 1?7) $ TOTAL
??110
RECEIPT RECEIPT
DOES OTILITY CONNECTION REQDIRE EXCAVATION IN POBLIC RIGHT OF WAY?
' Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
? ROADWAY" MLST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SOBJECT TO THE FOLLOWING COKDITIONS:
APPROVED BY:
TITLE:
DATE: [p.?L 9?? ? 6
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CITY USE ONLY
LOT D?l BL co RECEIPT #: & O I\3
SUBD. H-?d/ RECEIPT DATE: O/p/!
1996 M£CHANICAL PEfiMIT (ftESIDEN1'IAL)
crnt oF enswrr
3830 eaoT xxos su
ERfiAN IIN 881 EE
Date• g,z-o_? ? (612) 6$1-4675
Complete this section onlv if you aze installing HVAC in single family, townhomes or condos under
construction and not owner /occupied '
• HVAC: 0-100 M B T U $ 24.00
tu,ii i ivilAi, $v i? B i v 6.vV
• Gas outlets ( minimum of one required @$3.00 ea.)
• State Surchazge: .50
• TOTAL:
Complete this section on if you are remodeling, adding to, or repairing existing single family dwellings,
townhomes, or condos. Note: Mechanical permit is not required for alteration/add-on to ductwork in
existing residential units; but is required for the following:
LZ Install fumace _ Install air conditioning
Install air exchanger, i.e. Vanee system, etc. _ Other
Minimum fee applies to all remodel or add-ons of existing residences $ 20.00
State Surcharge .50
Total: $ 20.50
SI7B ADDRESS:
OWNERNAME: L?+TnaJZGR?V 7/GCf.?,p/'?G?(D PHONE#: YS"/-
INSTALLER NAME:
STREET ADDRESS:
AQd 651069ii0
PHONE #:
CIT'Y:
JS/FORMS SLD/MECH PERMIT (RES) - 1998
STATE: ZIP:
SIGNATURE OF PERMITTEE
L BL
SUBD.
CITY USE ONLY
APPROVED BY:
RECEIPT #:
RECEIPT DATE:
1998 M£Cf1i4NICAL P£RMIT (CObl14IERCIi4L)
CITY OF EAHlkN
S$SO PILOT KNOS RD
£AfiAN, MN 551 EE
(618) 6$1-4675
Please compiete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION Y INTF.RIOR IMPROVEMENT
DESCRIPTTON OF WORK:
FEES: i% of contract price OR $25.00 minimum fee, whichever is greater.
Processed piping - $25.00
CONTRACT PRICE x 1 %
PROCESSED PIPING
PERMIT FEE
STATESURCHARGE
TOTAL
SITE ADDRESS:
($.50 per $1,000 ofcermit fee due on all permitsJ
OWNER NAME: PHONE #:
TENANT NAME (nvpROVEmEx'rs oNLY):
INSTALLER:
ADDRESS: °`?`;" "cTIiOm"#??s"man
.,: ,J r ,
atc:_c.:a:r-• --:y?
CITY: STATE:'. tl ~V; ZIP:
3IGNATURE OF PERMITTEE
JAN.-08'98(THU) 08:25 DAKOTA CO ENY MGT
TEL 612-891-7588 P,001
/ 7/ .j?- ??i.
(J
Municipal Notice of Well Permit AppHcation
Dakota County finvironmental Menagement Deparhnent
Water and Land Mazlagemeat Section
14955 Galaxie Avenue West
Apple Valley, MN 55124
Tel (612) 891-7011 Fax (612) 891-7031
DATE: 7anuary 7, 1998
TO: Tam ColberHWayne Schwanz Fax #: (612) 681-4612
FROM: Water and Land Managemart
RE: WellPermithl: 98-11134056
Municipelity; Eagan
Well Type: Sealed
Environmental5peclallst Olsen
The Water and Land Management Section of tha rieknta County Environmemal Manag,ement naperfinent
hes received the following pormit appltcation for the weU dasoribed. If yoa rex{uiro further revfew of t6e
application w if you have any questions or concems about rt, contact rhe Environmeatal Specialist listed
ahove or our office at (612) 891-7011. If thera is no response from your offica within 24 FiOURS (cxcluding
waekends and hoL'days), we will assume that you have no objecxions to the issuance oflttc pe,mit Pleaso
note that pcrrnit issuanao is always conditioned on the permit applicant's observanca of and complianco witlt
all applicable stata, oounty, snd municipal laws and codes.
Well Contactor; Kiromas-Bauer Well Dr;lling
Date application received: 78nuary 6, 1998
Anticipeted Drilling Date: Tiate:
AnUcipated Grouting Daze:
Property Owner: John Truesdala
Well Owner. John Truesdels
WELC, IACATION:
PLS Coordinates: I/4, nw 1/4, sw 1I4, ne 1/4, Sx 12, Town 27, Range 23
:Street addresa: 331 S Hwy 55
-PINNuinber: 103200007100
WELL INFOTtMATION:
Diameter: 4 Casing depth: 72
Total depth: 77
Ststic Water Level:
Aquifer: Unconsolldated Sedimeuts
COMMEN'['S:
v?
S?
R-95% 612 891 1588 01-08-98 09:34AM P001 #21
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Use BLUE or BLACK Ink
I For Office Use
I I
I rn I
f I
Permit
City of E afl I w
I Permit Fee:
I
3830 Pilot Knob Road I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff:
L-----------------I
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: ?aL3 Site Address: 7 Y tLc~ ~`S S 4zil G E
Tenant: I Suite
Resident/Owner Name: R&r_V Phone:
Address/ City /Zip: 331!!3- 5SWa1'zf E_ 12014
Name: License
Contractor Address: City:
State: Zip: Phone:
Contact: Email:
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
Type of Work Sump Pump Repair / Repair
Other: o lb 77vU~ Other:
Description of work: R,cczeLL~ C) TJDQ~ (J-~lo~J
Description
~ bra f~ I ~
FEES
$60.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeacian.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU 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.org
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.
x x
Applicant's Printed Name Applicant's ignature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In -Final