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2997 Pilot Knob RdCITY OF EAGAN Addition ZEHNDER ACRES Lot 1 Blk 1 Parcel 10 88800 010 00 Ow?nerjlq!2/.Y?? 1n??Street 2997 Pilot Rnob Road State Es9an. MN 55121 _ ///_n rue _ Impro mem(/ Date Amount Annual Years Payment Fieceipt Date STREETSURF. 505 1984 2335.87 233.59 10 2102.29 A013901 5-17-84 STREET RESTOii. GRADING SAN SEW TRUNK -1-0 1968 100.00 3.33 30 43.39 A013901 5-17-84 lSEWERLATERAL ?/, 1970 2,310.00 115.50 20 577.50 A013901 5-17-84 W Sewi & Wat,,Service 1984 2085.38 208.54 10 1876.85 A013901 5-17-84 WATERMAIN * WATER LATERAL & gYll}.1S 1970 20 WA7ER AREA ? i STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 230.00 2109 1-7-70 9UILDING PFR. SAC 9109 PARK CITY OF EAGAN Remarks Addition ER ACRES Loc 1 aik 1 Parcel 10 88800 010 00 Owner Street 2997 Pilot Knob Road State EacJall, MN 55121 Impro ment Date Amount Annual Years Payment Receipt Date STREETSURF. 505 1984 2335.87 233.59 10 2102.29 A013 Ol 5-17-84 STREET RESTOR. GRADING SAN SEW TRUNK 1-0 1968 100.00 3.33 30 43.39 A013901 5-17-84 tkSEWERLATERAL -76 1970 2,310.00 115.50 20 577.50 A013901 5-17-84 Sew F Wat, Service 1984 2085.38 208.54 10 1876.85 A013901 5-17-84 WATERMAIN *WATERLATERAL & 3tIIb8 1970 20 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 230.00 2109 1-7-70 BUILDING PER. SAC _ :70_ PARK CONTRACT Site Address Lot ? Name m ? Address c City _ Name c Addre 4 CitY - TYPE OF WORK Forced Air Boiler Unit Heater Air Cond. Vent Gas Piping Outlets # Other PERMIT # MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ' PHONE: 454-8100 _ Sec/Sub Phone & BLDG. TYPE WORK DESCRIPTION Res. ' New Mult Add-on Comm. Repair ' Other FEES RES. HVAC 0-100 M BTU -$24.00 ADOITIONAL 50 M BTU - 6.00 (RES. HVAC INCWDES A/C ON NEW , CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PEkMIn - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE APT BLDGS. - COMM. RATE APPUES TOWNHOUSE & CONDOS - RES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 REMODELS - 12.00 M{NIMUM COMUIcRCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000) -; , :12;.) M BTU M BTU M BTU M BTU CFM FEE S/C: SI E P ? TOTAL• y . '??a FOR: CITY OF EAGAN ? ? .,iw, rv.*. c.A*'- Yr?s-r1?5 INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: •W1+111!Mf, 3830 Pilot Knob Road Permit Number: 1% '•,i! n Eagan, Minnesota 55122-1897 Date Issued: 41, (612) 681-4675 SITE ADDRESS: ' APPLICANT: IiN lIi f; #1( I:t.S ( f- t:') A! - F L ? PERMIT SUBTYPE: TYPE OF WORK: Pormk No. Permit Holder Date Telephone N ELECTRIC PLUMBING HVAC Inspectlon Dete Insp. Commertts FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FfG DECK FINAL INSPECTIDN RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date issued: (612) 681-4675 SITE ADDRESS: ,"I (1 : f' I l r) I PERMIT SUBTYPE: I li1 1 1?? f1f_.t I tJii?i F:{1 APPLICANT: ,1i , . i I TYPE OF WORK: ftFplAP'k':'i - A',1'I'AI4AFf VVI,MII 1f.'Ji3111V1'll fOFt AfdY 1if1;1}4 1 i'A1 G.illlr! ? J Permit No. Permit Holdsr Date Telephone N ELECTRIC DO O ?3 9S ? ? PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING /(-i A-?v ? Cl ROOFING ROUGH PLUMBING PLBC3 AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BIDG FINAL BSMT R.I. BSMT FINAL DECK FfG DECK FlNAL 0 1 ?-986 ? ? ReQUest oate ` ' / Fire N. ow7n-In Inspgjlon Fequiretl (Vou must cell inspector ?reatly) Inspeqion Other Than ughdn ? qeatly Now ill Nolily Inspecbr , ?/ ?S ? Ves fi No Date Featl 4t ,,1ner hereby request inspection of above electrical work at: I? licensed contractor q Job Adtlress (Slreat. 8ox ar Rou/te?No.) / Ciry ? / T/<cT he6 ?Y' Section No. Townshlp Name or No. Range No. Counry Occupanl(PRINT) Phone No. Power Supplier Atltlress Elect cel ConVactor (Company Name) . Cmvacror's License No. rAty Ll1 r `IV- Mailing Atldre;s (ConVactor or Owner Making Installation) / W? e- orizetl naNre (COnVacto Owner RI g I Ilation Phone Number ysa-?? ? 3 MIN SOTA STATE BOARD OF ELECTRICITV nn I I TMIS MSPECTION FEQUEST Wlll NOT Gd s?Mitlwey Bldg. - floom 5128 (I I I I I 11 I I I I I II I II BE FlCCEPTED eY THE STATE BOARD 1827 University Ave., SL Paul, MN 5510G II OPER INSPECTIDN FEE IS UNLESS Phone f6121 692-0800 ! . ? NCLOSEp. E 1llzrj REQUEST FOR ELECTRICAL INSPECTION ? See instructions lor completing this lortn on back of yellow copy. 47,01 ?`??Q y/ "X" Below Wak Covered by This Request Ne% Ad ep. Type of Building Appliances Wired Equipmant Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm./Industrial Furnace Other (Specif ) Farm Air Coriditioner Other (specity) ConUactor's Remarks: Compute /nspection Fee Be/ow: S ?a? w # Other Fee N Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200_Amps e 100 -Amps $I f15 Inspector's Use Only: ' TOTAL ? Irrigation Booms ??'? OCM S ecial Ins ection AlarmlCommunication , THIS INSTAILATION MAY BE ORDERED DISCONNECTED IF NO7 Other Fee COMPLETED WITHIN 78 MONTHS. I, the Electrical Inspector, hereby if i h h b i h Rough-in , . oaie cert y t at t e a ove nspect on as been made. Finai ,. . oate yj i OFFICE USE ONLY ? This requast vaitl 18 manihs irom ?,ht e6/24/92 ie: 17 DpCOTR COUJTY-I.ESiQdJ SERV. CTR. 001 y '?Oaj .. Ordinance No. 114: L I W Ze4dQY ACreS WELL AND WATER SUPPLY MANAGEMENT MUNICIPAL NOTICE OF WELL PERMiT APPl,1CAT10N OAKQTA GOUNTY ENVIRONMEMAL MAIVAGEMENT []EpARTNEENT WATER AIVp LAND MANAGEMENT SECTEON 14955 Galaxie Avenue West,App le Valley, MN 55124 Telephone (812) 991-7011 . racelmas (612) 891-7031 DA7E: GlZS MZ.? 71ME: TO: r7'avn. CpC.P??1,TA1KYAJl Ar?t SENT: ax ,. MaU„_,,,, Other. FROltll: REFERENCE: NOTICE: The Water and Land Management Section of the Dakota County Environmental Managsment Department has receNed the following ermit appUcation(s) forthe well(s) described. It you require furdler revlew of this appltcation(s) or ipf you have any questions or concerns about it, contact ttre Environmental Specialist Usted abovs or our office at telephone (612) 891-7011. If there is no response hom your oiiloe wRhin 24 hours (excluding weeKentls ana holitlays , Water ana Land Management eCaff wiil assume thet you have no objectiqns issuance of the permR(s?. Please note that permit issuance is always condklbned on the permit &pplioariYs observance of and compliance with ali ap licabla laws and codes. A copy oi ehe welf permlt(s) will be forwarded to your offico when competad. DESCRiPTION: PROPERIY:OWNpi LOCATION OF WELL(8): , PUBLIC LqNp $I MUNICIPALITY: WELL CON7RACTOR: APPLJCATION RECEIVED SUBCflNTRACTED TO• L1CEtdSE 140.60aZ p6AMR TYPE:NEW CONSTRUC7IQN pECONSTRUCTION REPAIRQJepamtitqaqukod) PERMANENTSEALINQ d--ANNUALMqINTENANCE: TEMf'OAPPING BEGAIMEDAM17- ? ...... .. REGISTEFtEb-USE? pRIMARY USE OF WEtL(S) CA91N0 DIAME7ER 4e IrvCHES; LENGTH ?,24:7_FEE7; WELL DEPTH_ .Z 7eZ.. FEET; AOUIFER COMPLETED: OPEN HOLE- SCREEiVEO L--; r? -- AtJTICIPATEDbRIU.INRJSEALINQ6A7E(HKnowry; G(JMMENTS- 03/04.92 13:33 Dwcr7A aINTY-4E5TERJ SERV. CTR. 001 r Qy, Ordinanc0 No. 114: WELL AND WATER SUPPLY MANAGEMENT • MUNICIPAL NQTiCE OF WELI. PERMiT APPLICATION DAKOTA COUN7Y ENVIRONMENTAL MANAGEMENT DEPARTMENT WATER AND IJWD MANAGEMEN7 SECTION 14955 (3alaxie Avenue West, Apple Valley, MN 55124 , Telephone (612) 891-7011 Facsimile ($12) 891•7031 DATE, TIME: ,eM M SrNT: Fax d!Mail Other. TO: -r orn m0-RWr LullYU E 4qQMt+s1AtJZ - FROM: REFERENCE: QZ- w NOTICE: The Water enti Land MSnagement Sectlon of 1he Dakota County Environmental Management Department has recelved the foilowing permit applioation(s) tor the we11(s) desoribed. If you require tuRher revlew of this apPlioaiion(s) or if you have any questions or concerns about ft, contact the Environmental Specialfat {iated ebove or our offiee at telephone (812) 891-7011. If there is no response from your office within 4 hours (excluding weekends and holidays), Water and Land Management staff wlll assume that you have na.objections issuarice of the permit(s). Please note that permii issuance is always condiUoned on the pertnit applicant's observance of and eomplianee with afl applicable laws pnd codes. A copy of the weN permlt(s) wiU be forwarded to your of#ice when compteted. DESCRIPTION: PROPERTY:OWNER F? I 1NFLL(nomereN LOCA710N OF YJELL(5); ADDRESS A 2r1 C ?j { p(.$ ?L? PUBLICIANDSURVEYC00RDWATE : O-OF OF-OF ECTIbF?-,f. N., R.-W., MUNICIPALIIY: ` ^ PROPERTY ID N WELL OONTRAC'fOR: -'!Mf $lk1 Ltr/1 Cw UGENSE NO.,15V6b APPLICATION REGEIVED $'. SUBGON7RAGTEDTO: pERMIT TYPE:NEW GONSTRUETION V? AECONSTRUCTION REPAtR(w wrmhFUquhod) PERMANENTSEAIING ANRWrWAINTENANCE; TEMPORAR1 UAPPING RECWMED-l1SE- REGISTERED-USE WMAAY U3E OF WELL(S) %IM/iJ/7bJZ[/V?e 6'gWA0469"TL CA81Nti D{AMEfER q 7'&' 2 N INCHES; L&NRTM 40-'" .. U' FEET; WELL DEPTH 'I ? FEET; 110UIFER ?????MI/C(, CCIMPLETEp: OPEN HOLE- SCREENEDL-7 AM11T1CtPATED DRILLiNGJSEAIJNG bAl'E(R unorm): COMMENTS: RECE/VED JUIy 17 L No, Rennor 8 Sons 5? '?"?s ?°„ N.Wf 9k RMe?MN 5 330 1992 lNCORPORATED (812) 427-6700 fax: (612) 427•0533 Date: JUN.16, qQ2 MINNESOTA DEPARTMENT Of HEALTH 717 SE DELAWARE STREET DIVISION OF ENYIRONMENTAL HEALTH MINNEAPOLIS, MINNESOTA 55440 ATTN: Mr Jim Nye (612) 623-5339 SUBJECT: MELL ABANDONMENT RE: NOTIFICATIDN Dear Mr Nye, SITE DIAGRAM NORTH This letter is to notify you of a water weTl in your district that should be sealed according to the Water Well Construction Code MCAR §4725.2500-2900. E.H. RENNER 8 SONS, INC has been notified by the owner of this property or an interested party and have subsequently submitted to them an estimate for the sealing of this well under our LICENSE #71015. We have also included a copy of the current code with our estimate. In submitting our estimate, the owner may also receive additional estimates and hire any number of Minnesota licensed water well contractors in the area to seal this well. However, there is a possibility that this well may not be properly sealed and thus jeopardize the ground water and Public Health. E.H. RENNER 8 SONS, INC. wishes to provide you this informatian for future reference with the abandonment report when submitted. PROPERTY OWNER: RUTH MERRILL ADDRESS: 1381 OUARY LANE EACAN _ MN _ S9121 LDCATION: SAr1E Sincerely Submitted, Raymond T. Renner, V-President E.H. RENNER & SONS, INCORPORATED STATE LICENSE i71075 CC: CITY OF EAGAN 3830 PILOT RNOB ROAD EAGAN, MN. 55122 ATTN: PHONE # 4s4-4n3a DATE 11-25-91 WELL DIA. ¢w DEPTH: 25p1 + 8322/52 11:3e nacoTR 0owrr-uesTER4 sERV. c'ra. eei r Ordinance No.114: WELL E(ND WATER SUPPLY MANAGEMEtVT. MUNICIPAL NOTICE 1f7F WELL PERMIT APPLICATION' t?AKOTA COUN1"Y CNVIRONMENTAL MANAQ?MENT QEPARTNIENT WATER AND LAND MANAQEMENT SECTION 14955 Qafszla Avenua West, ApPle Valiey, MN 55124 Telephone (612) 881-7011 Facsimlle (012) 8914031 l.JGyne ? ?ou ? ? ? DATE: ?;z6j?,Z? TIME: nn?n SENT: Fax L--IVlall Other TO: FfIOM: REFERENCE: -VL-* ?? ?., NOTICE: The Water and Lend ylanagement S9ction- of the DaKOta County •Ernrironmental Management Department has received the fo!`owing permit appllca6on(s) ?qr t(ie wsi!(s) described. if you requlrs further review of this applicafion(a) or if you have any questions or.concerns about it, oontect the Environmental 3peoialist listed abava or our.offloe at telpphcina (612) ??J1-7011. If there is no response irom your office uvlthin 4 ho.= (exdudfng weekends and holida? y,s , Water and Land Management stafi will aseume that you ha?+?:.no abjections issuance ofi the permtt?;s;. Please note thet permlt issuenca is aiways condidoned on the pormlt appllnar,t's abaervance of and oomplianco with ail appffcable laws end codes. A copy of the well perrni+(s; wili ba forwarded'to your dffioe vvhen completed. „ ? pESCRIPTION: ' .. , .. PROpgHIY:OWNER . ?MLr, SW??ff k^! WELLIpONaienq .?: LOCATION Op WELJ.(8): qCpRESS ??? ?r. ?', , PUBLIC LANd SURVEY COORDI ES: vil _ F? ?OF. SECfiION J.. M.A.-W., MUNICIFyALITY: PROPERT'?)D hb.'- WEU. CONTRqO'I'pR: -7m --rfi-? (ZOJ C, LJCEN6E NO.. 07 /?L . APPUCATIONRECENFD -VAJ/-?'yZ. SUBCONTRACTEDTO: PEqMlT TYPE; NEW 'CON$TRUCTION R6CONSTRUCTIOPt REp/UR(NO PamirRoquln? PERMANENT8EALIVQ ANNUALNAAINTENANGE:"fEMPO?ApPING RECLAIM6p•II?E r i REfiISTERED•USEr?F IARY USE OF W6LL(S) --?--- CA31NQ DIAMETER INCHES; I.EN(3TH FEET; WELI. DEPTH? FEEf; AQUIFER ???.. COMPLETED; OPEN FiOLE SCSEEh1ED L-}?; _ - ? ANi7CIPA7EG.ORILLINa/SEALINC3 pAl'E(nKnown): • ? _. . _ . i COMMEN7S: ; , {. 3> kIiU?NB, 1d2 VbAUJI?I Q-4_711T-I11t51E1d4 tiF]r!. LIR. 00 1 Ordinoncc No. 114: W[=1_I._ AND WATf'll ;l.ll'PI_Y MANAG?15MCNT MUNICIPAL NOTICE OF WEL.L PERMIT APPL.IC741'ION DAK07A COUNTY ENVIRONMGNTAL Ml1NAUL=MENT 0(=PAIITM[NT WA7ER AND IAND MANAGEMEN7 SECl ION 14955 Qalaxle Avenue Woct, APple Valley, MN 65124 Teleplioite (012) 891-7011 racslmile (812) 891-7031 UA'fE: ? B 9Z: TIME: _1,3:30 ._ reWPM SENT; Fcuc ?MniIOqier 70: TGm Co(Arx FROM: ,eor,ft Gd/- ,?;, fiEf[IiENCE: _92_ _ .9/Z 4 : .l. C?- iTrilf NO. --- -•_,...?__._..__ , _.. . . NOTICE: Tlie Water arid L.and Managemern 5octlon ol the Dakota County Envlronmental Managemenl bopartment has recelved ihe followlng permit arpUcation(s) tar the Well(s) descr(bed. If you require further revlew of this appi(calion(s) or i( yuu have eny questions or wncems about It, contact the Environmentat Speclallst Ilsted abovo or our office at telepi7on9 (612) 891-7011. If lhere ig no response iram your offir.a.withln 2 hours (excluding weekends and holidays), Water and Land MAnagoment etaH will assume that you iave na oujections Istuance of the permit(s). Please note Uiat pennit lssuanae ia always condhloned on ihe peimR tapplicant's ob9orvdnCe of and compliencP with all appIicable laws snd cades. A Copy of the well permit(s) wiq be fonvarded ta your of(ice when roinpleted. • DESCpIPTION: PRUPERIY:OWNEN b4UkA I:OK•f, ILt itY_?_yyELL(uonrorany LOCA710NOFWELL(S): nppRESS (9-{-a? CItff- kU7lD( . rueuc uiND suRVEtrcooFT_DN i§i-?o??Fi{?? oF,?7? sFC o r..?_2, ., R.Z? w., MVNIGIPAIJTY, 4 ,ret a rt?,yt WELL CONT'RAC7Oq: /G}AheY' We_II0 ) r jf/li LICENSE NO. /930 /_ APF'IICAIIVN RECEIVED ?ri 6"' 9Z 3UBCONI'fiqCTED 70: ....__- I? PEFiMIT 7YPE:NF-W CONS'IqUVIION R[CUNSTRUCI'ION REPAIp(NoroimiIRequlrodo PEIIMANENT 6EALINl? x ANNUA! ti1nIN1ENANCE: TEMPOIlARV C PINQ pCCL/11MED IISE REl?19TEREb-U9E PqiMAfiYUSEOF WELL(S) ASjr?/'. p{pp+u?j({ypr17r? r?haW KnttlB CASINQ bIAME'fER ? Z -_INCHES; LENQII l. ?{- FEET; WEI.1. DGPTH ('08 f EET; AQUIFEq ?('af+drIl•dvW,/ COMhLEfED: oPEN MOLE? SChGCNEDjX• . AN'tICIPA7EUURILLINQJSEqLINQDATE(IiKnown)t 74(,('o4m f Turu 9 ? /99Z ,9;00 ,44 1 ..--- c;oMMErvrs: SIAIE UF RINptSO1A UtMAItIFtN1 UF HtAI.IN ABANDOMm MELL RECORD 1. L001TIOI1 Of Y[lL c°°"" "° Dakota Tamnlp Nuw Tpmtnl0 NuiWr Pmpe NrMr M E o? sr Faoan 1 7 e 0-2 wxu.rrtcat serr.t Aaanu uW dtr oe w11 loueton or Intvfe<HOn 1081 Kenneth St. SMw exact laadon af rll (ln aecHOn 9r10 rlth 'I') Y M a E T y w. I_ M 55121 MINNESOTA UHIq1E YELL N0. ? (i.... ei.nt v w< <?) b. inctton 4. YELL D[PTM (COmpLbd) WN gul?d 4 % o, d NW NW ?t. United Real Estate vrop?rtr aeano i.euaua .ee.. Serv ices 1671 Walnut Lane Eaean. hW 55122 1. rawurcan ws coLaa rovwiTIa raa To l/ not Ynmm, InE1ate Ierqtton laq /rw nw w1i or warCy ril. s. oqZylMa i[nwo (ir tee.,n ) 4Cal1e taol 10 Mwne 70 7r1wn 1CO Wq 70 Mol lar ReG 5oAfr g] larM 11[] x] bUry EC] JettN 1Q Powr Au"r 6. 0lSTNUCTIOMS 1411 oGStruc4d16 Q b ONLruttl0n ?svN tH ro [3 b 11 OOstrtKtiOnf Gonirot !1 rao•N. wntact IWI Eefon su11n0. ItkDOr+t1c Q IbMterlip Q IMst Loeo 1[] IrNqatlm !Q PulNc 90 Inluttrr ?p r.,o wn do wnic+wi iop cer.n.i - 7Q11tr ueatcfminy 110 IM6(5) ? el.ct ;I?7hrnaN 70 tp c.i.. ep wtae 7?n..s,c 40 :ufele.asa.l I.. co 142 re. i., u n. 146 "' &5,„.,,., ..,, r,a. 142 rs. m146 n. (It Uove) ? oMM xol0 ho. _ rs. m_ tt. 10. SiATIG TFR IFYE ? (w ft?M10? ? Sbor6 / I Ian! w Ce G4 IYnund 10 ll. KLLHUD CdiLFT10N 10 net..s Aa.ou. 40 rou.a wriea ? e..~t emee r1,'+ wn ne Grout 4" Well 146' Deep. 12 Bags Cement 14 lbs. Bentonite 2 Men, Labor, Rig and Cement Grout Rmp. Mat Crmt C) NntnMta 3(]??/? t Yur1e1 'ra???pio 0 ft. cu. yes_ 13. MFk11LST SW0.CFS Of COIITAIIIIU1T10M reee ai..enw eyo. Wlt l/HnhetW Mton ...nn9r ? r.i i/. PN1P UU7C?swA ? bt PnNnt iypr ?p? SuOwniC1• ?] L.S. Turitno ? RNlprvnHnq ', 20 At Q Gnerlfu9a1 f0 IS. FxISi1Xi YEW (Vlease t4tcR locaHOns of aGantlonW *ne aeNw wflt In rMartt o or on Wek.) OtMr unu 11(s) on OAOortYi 0 7ef Xe 1lbnee?rA?/nrnmt [3 Twponry [:I Mail e IeA TMa rtl wa tul*A untler ry JuNtEictlon anC tMt npert 1s Vw to CM Mst ot ry Lmr1W9e anE MI1o/. V ST'nDOLA wcLS. Ik2ILLING CG., INC. Litensu Wsinof Xor 27172 lInnsl ft. I uam.. sion.e rnem Aerumuo v[u ucau (wy a u.w +er rrop..er Tr..u.r) I ?r sr ro-aerAr. rru Wri nears SYettll Mp 0/ yli 1"iHOn 0"1i5¢ 08: Sa naKOTR CDlNT1'-4.ESTE3dJ SERV. CTR. 091 (,?a y n t. ., Ordinance No. 114: WELL AND WATER SUPPIY fv1ANAGEMENT MUNICIPAL NOTICE OF WEI.L PERMIT APPLICATION DAKOTA COUNTY ENVIRONMENTAL MANAGFMENT DEPARTMENT WA'fER ANO LANO MANAGEMENT.SECTION 14855 Gaiaxie Avenue West, Appte Valley, MN 55124 Tdlephone (612) 891-7011 Facalmpe (012) 891-7031 DAl'E: G/l Z52? TIME: ?PM SENT:(5- Mail_ Other TO: 'Tt^?M. C'oL86'.6L'r/wAVUE 5'CFwAt?IZ _ FROM: REFERENCE: NOTICE: The Water and Land Management Section of the Dakota Counry ErnAronmentai Management Dapartment has recaNed the fallowing permit appiication(g) for tne weu(s) describea. If you require further review of this application(s) or N you have any questions or concerns about it, contact the Environmental Speclalist Ilsted above or our oflice at telephone (612) 891-7011. iF there is no response irom your office wfthin 24 h rs (exciuding weekands and holidays , Water and Land Management staff will assume that you ave no objeations issuance of the perrnh(s;. Please noie that permit Issuance Is always condhioned on the permlt applicanYS observancs of end compliance with all epplicabla laws end cotles. A copy of the weil psrmrt(s) will be forvvarded to your office whan completed. bESCRIP710N: PROPERTY;OWNER WELLpi pnreronq LOCATION OF WELI(S): ADORES6 ? kQ'QF,? } , , PUBUC LAND 9URV?EY ?C00RpINA ? 6f 04.. OF SECTION ,?`. MUNICIPAL.ITY: r?] ?-- . . PROPERTTI-D-146.- WELICONTRACTOR: ?, §A,'J' JVJNhM LICENSENO.Z/G/ APPLICATION flECEIVEb 5727 A 2- SUBCONTRACTED TO: PERMIT iYPE; NEW CONSTHUC710N HECON9TRUCTION REPAIR(No PomM Rpulnd) PERMANENT 9FAIJNp VANNl?T1L MAINTENANCH: TEMPORARMPPING RECLAIMED-UVE - REOISZ'EREO-USE _15MMARY USE OF WELL(6) CA61NG DIAMEfER ?INCHES; LENOTH FEET; WEI.L DEPTH /O(R ? FEEf; AQUIFER SM& COMPLETED: OPEN HOIE SCREFNEO 6--; lwnGPRTED ORILLMQ/SEAUNG UA1E(a Know„J; COMMENTS: - es/ia/9z isss - nFrmra arJNrr-t,esraer sEr). cm. Ordinance No.114: WELL AND WATEFi SUPPIY MAryAGEMEN l MUNICIPAL NOTiCE OF WELL PERMI7 APPLICATIOTI DAK01'A COUNTY ENVIRONMENTAL MANAGEMEPII' UtPARTMENT WA'fER AND IAMD MANAGEMENT SECTION 14955 Gafeude Avanue West, Apple Vailey, MN 55124 Telephone (612) 891-701 i • Faos&nils (6iz)ss1-tiaa1 DATE: : S t ?- TIME: AM PM SENT:_ F87C X Mall Qther 70: •l"oM Cnl?pr+ I r..? ?..ne ?,I,..,nm? - ? muwiLiirAL vrriUIAe. ? 71TLE • 7ELEpHONE 6 9 -ql MurviciPAUrv . uR? s FACSIMIL FRonn: LL,?ejr;rs 8i1-755 3 EN IRONME 7ELEPFiON6 REFEREIVCE: ?7? _.JO ?TS NOTICE: TIZe Water and Lend Management Section o1 the 17akota County Environmental Managemerrt Department has received Qie followirig permit applicatlon(s) for the well(s) doscrihed. ff yau require further review oP thie appllcatlon(s) or if you heve any questions or concerns about it, contact the Environmentai Specialist Usied above or our office at.telephone (612) 891-7011. !f there Is no reaponse from your office wilhin ours (exctuding weekends and holidays, Water and Land Management sta(f will assume that you have no objectlons isSuance of ihe permit(s;. Please note Qiat permit Issuanoe is alweys conditioned on the pemiit applisant's observance of and eompllance with all applicable iaws and codes. A oopy of ihe We11 p2tmh(s) wID be iorwarded to your oHioe when completed. . ft? DESCRIP710N: . :10-p?3oca-ara-77 PROPERI'1';OWNF_R COlQ. WEIi(nWHeronQ LDCATION OF WELL(8): ADORE33 .S0tjA Lena5f-&7 , PUBUC LqNO SUFNEY COOaDINATE ;___OF`UF OF sr OF BECTIbR_J_,T.^ ., Rh-a-W„ MUNICIPqG(TY: - PAOPERTY ID NO. INELL CONTRAGTOR: LICEtdSE NO, A('pLICATION FSEGEIVEl3 S a SU130ON7Po4CTE0 TO: ?1 pERMIT TYPE:NEVY CONS7fiUCT10N RECONS71iVGTION REPAIR(NoPetmMpoqWmrQ PERMANENTSEALWq?ANNITARMINTENANCE: TEMPORARYCAPPINO HEClA1MED-USE REGISSERED-USE. pRIMARY USE Of WELL(8) - CA51N(3OIqMETEA p? RVCHES;I.ENQ,TH L3& FEE'f;1NELLDEPTH j yo --FEE7; ALfU1FER _"LOASn(?'0kck?ej ? MIEAf-S COMPLEfE4: OPEN NOIE? 9CREENED)C; AN7ICIPATED DRILUNGJSEALINO UATEQf Wiowr4: onk-Apu,,n COMMENTS: srah aF niKNEsoTa nEPnetrM of xEaLn+ ck)qj ro -AB1INDONED MELL RECORD -- ? e ? ?- r Tuutia ar v[u MINNESO7A UNip1E IIEU N0. ?1?11 couns, w.. Dakota n«.s u.n. I..?t knonum) TewiaMO Muee Tminanl0 NuYer qnp "r Seciton No. Rattton 4. YELL OEPiII (wptoUd) W4 ax1ed Eagan 27 " 23 20 NlJ` IB€' S 210 n. 4-20-92 Y INrr1a1 Stnet AEEnis and Ctty p/ WIl Lecatien or OffUace /m RpaE S. ORItLiM61EiXOC (f1 kneyn) intenecNan Gl1e teol - 10 1[] qwm 70 Or1wn 1l[j Dug `?$020 Blackfiawk Rd., Eagan, M(1. tpxettio.fta 1[3 Air epeo.oa »p Stav enct la?tfoa af w11 ? N. T ? 30 P°ury ' dgttN So Ywwr Iluqer (1a saNpn 9r10 dth •T•) . N 6. 065T0.1lCTtONS Y .4 . • • --6/ W l l ebstrue4d ffYes ? b Obstructtoas rrerN0 ry [] No. If alttrvetfen: unmt Oe nmewA. wnhct Imx E aron w.ltny. 7. us[ h•t ? 70 Oarsne (] ibntiortno e0 xuc laon I 1'"? -=T` ! 213 trriwc+on ep r.eim fp teeu:e*r 1 30 r.so wn Cl Nmieiwt tCooemm.R+.i i- 1wL I 2. FAOiERi: GYNER'S 1iFNE q111O AOlryif 1t dllhrynt [Mn iFN , vrov.rey .aansS +eaie.uu oeme ' Gary Selva 14lPOME55 Of 3. iOPMaT10M I.OG COLON FpRMATION FpOM Tp If net Worn, lndteab forrttoa leq Im pb rll ar eprpy wil. Cla 0 166 whi soft 166 177 -Sand NOTE: It was not s ndrock san 16. REM0.RIG5, ELEYATIOX, SpURCF Oi GtTA - G$I163 NUqYEG, G$JNGS iEliOMTEC. ETC. Geology taken from a well we drilled in 1974 on Englert Road (NW of SE of SE, section 15, township 27N, Range 23W) Gary Selva (612) 454-0565 Office (612) 828-6220 Obstructions removed: 119 feet of wood rod. Their water supply comes from an active well in front of the house. I OvvuuL Auwooxco WEu accaao (wr w usoa fe. neo.nr rran.r.r) sOMr?sz. rzrs sm em I 704tr asarste???o »p H. GSIN6(5) ' I[] BiBk 4M i6eppW 70 90 aI.. 10 wie.a 20 rt+ss+e to sa+.las swl 2 ,a. e, 265.e. 1n. te ft. . 9. SC0.Ed ¦ sa„a.d mn tnn 206rs. u 210 n. (v wmm) ?oqn xe,e no. _ tt. se _ n. x 10. SiA71C WTEIt LEYEL - . 1f. S Mlor ? a6ew ?q .? iua sunan au Me..una 4-20-92 u. WELiEM cavLcnae 0 Htlpa AGOGr Q Foue1 WMed go Gsslnt NftoY ' S[] 43 WIl Mt 12. 6POU"IN6 [MipWN7I0N 0 INat CWnt 90 Mntanlp' 313 im .ur,.,Neat ,,a._ _,?? cemen !1. - - 17. "H°`ST SWRCESOF AXItl?tTION +,f? S9?a,mt," floor drain ?e wtt ais+.r.csw eerer. witnyt 0 r.c 14. PUlV 49 WMrW Q IbL irecent T7VS: 10 Suhmn101e 30 LE. iur4/m 0 qectoMcatinq 20 j.s Q wnMfuy.i ip 15. EIISi111i fIELLS (?Lap sqtch loutlatf oI aWnAOped anE "t1w wttt tn ,srq pcHan or oq Wct.) osn.r wnw wiil:l en meo.reyt ? ra M we AMelonM: Cl MrrMnt 13iwpnrY d Net sn1eE 17. WTE0. YELL CpIITpACTppS CEpT(FIUTiON Tlits .etl wS sxtetl unlv dJurlsA/tStoa Ind thts repo,t e fs t'w te tM Mst eI q knowlM" saG bellef. ' r:artmann Well o. 40174 }68"'P.wFtyffi"'3't., New P'RWP2',• Mn. 6 ?am.:. - - R.7ert c an au. w.e e+ onn.r l71 iqFRJ. cnz. Ordinanoe No. 114: WELL ANU 1NATfR SUPPLY MANAGEMENT MUNICfPAL NOTICE t7F WELL PERMII' APpUCATION QAKdTA COUNTY FNVIliDNMEN7AL MANAGEMENT DEPAFI7MEN7 WA7FR AND IJAND MANAGEMENT SEC710h! 14955 Qalaxie Avenue West, Apple Valley, MN 55124_ Telophono (612) 881=7011 Facsimile (612) 891-7031 DA7E: 31,-?019g Y'IME: _j6pM SENT: Fax -4-Mau- Dther TO: T6?,r??. ?rA? oFFi nL TinE T€Lr=pnz5Nr- FROM: pEFERENCE: NOTICE: The Water and Laitd Manngement SscUon oi the bakota County Environmental Managvment Department has recelved the following permlt appllcatlon(s) for the well(s) described. If you require turther review of this appiication(s) or ft you have any questions or concerns aboid it, contact the Envlronmental Speoialist Ilsted abova or our oifice at telephone (612) 891-7011. If there is na response hom your oftico witnin 24 hours (excluding weokentls and holitlays), Water and Land Management stntf will assume that yauTiave no abjectfons issuance of the permH(s). Please note that pennlt Issuance Is aIways conditioned on the permit applloant's observance of and compliance with all applicable laws antl cotles. A copy of the well permit(s) will be torwarded to your oftice when completed. DESCRIPTION: Pi'iOPEfiTY:OWNER ???_ Q?N?? WF_LLQlbillment) LOCA710N Of WEIL(5): ADDRESS ??? '?1CF _ rueuo LaNO sur?vFrco r?61r7n? ?'-"? ?'t??i?--,?.?N„R. R MUNICIPALIIY; ?^?? ? PRDPERTYTNO. ? WELLGON7RACTOFi: (11cL( UCEIJSENO. pZ71-7a_ APPUCATIONR£CEIVED SUf30ONTRACTEI?TO: .__.,_.....Yy- F'ERMIT TYPE;hJEW CONS411UC)10N RECVNSffiUCTION REPAIR(NoParmhAequLal) PERMANC-NT 6C-Af.ING V' ANNUAL A1f111Jt'ENANCE: TEMIPO 7Y APPIN(3 RECtAIMFQ-IiSF REGISTEREl7-USE_ PfiIMARY USE OF WEI.I(5) CnSINQ DIAME1"EH NCIiE6; LENGTII _(?(p FFEI'; WFLl-pEP7H ? FEET; AQUIFER GVMPLETEU; OI'EN HOLE- SCFlECNED 9?; AN7ICIPATF[) I7RIf.l.1}JG/SEALINnt?ATEItfKnnwn):--I/,t"NOWA? CDMMENTS: .... I.: b:? I !,Ia vn;Dra co-"n-4,FSrFr?r1 SEP!. cTa. 001 •= ?a:r = Ordinance No. 114: WFI._1./1Nn WATER sUPPLY MANAQEMENT MUNICIPAI. NOTIGE OF WF-LL I'ERMIT APPLICATION dAKOT11 COUNTY ENVIf10NMENTAL MANAGEMEN7 DEPAR7MENT WA'fFR nNfJ I_ANb MANAGEMFN7 SFCTION .14955 Galaxle Avenue 1Nest, AppiB Vailey, MIJ 55124 7elephona (612) 691-7011 Facsimite (012) 891-7031 DATE; iIW/%a _ TIME: nM M SEN7: -s Mall_ 01hef_ TO: ? ? f lPA 0• tCIAL T1TLE TEL PHONE . FROM; RFFFRENCE: 9z - fR2 I ?!Z WEl PERM(T 0. NOTICE The Water and Land Management Seclion of the lJakota County Environmental Management Department has recelved the tollowing permit appllcatlon(s) for the well(s) described. 11 you require lurther revicaw of tllis Etpplication(s) or if you have any quesdons or concerns about it, contaot the Environmental SpeCiallst listed above or our office at telephone (612) 891 •7011. H lhere is no respvnse irom your otttce wicnln 24 hours (oxclutling weekentls antl holidoys , Woter ond Land Management staff will assume that you have no objections fssuance of the permit(s?. Pleasa note that permit issuance Is aiways conditioried on itw perrnit applicanYs observance of and compUance with all applicable laws and codes. A cnpy of the well permlt(s) wlll be forwarded [o your otflcv when cnmpletod. pESCRIPTION; PFtoPertTr:dwtaEa ??j?? ????? WELJ-pl PlNerenV t.DCAT1qN OF WELL(S)! ADDRESS PUBLIC LAND Si1RVEY COOR INA1 ES: UF Uf- Uf Uf- 6C?-CQN ,T. N., R. W MUNfCIPALITV! `??? ? y? _PROFERTYID N0. wELL coNrRncloRi u1'FN9FNO APPLICRTION REGFIVFD SUBCON7RACTE0TV: PFRMIT TYPE:NEW CONSTRUCTION RECONSTRUCTION REPAIR(NorermxlteqvliadQ PFRMANENT SEALING +?''ANF47JA-LMAINTENANCE: 7EMPOfiNiY CAPPING RECLAIMED-Ut? REGISiEIiED-U6E ?ARY UiE OF WEIL(3) ??-_ CAStNGpIRA1ETER __q -11INI:liE5;1.ENGTH I3G' f[ET;WELLDEPTII_J4 ? FEEI; AOUIFER COMPLEiED! OPEN HOLE? SCRPENED 7 ?M'ICIPA?GD DRiILiNC/SEALiNG L?AIGpnc„n.,.,l? f,l/V?? _._.. .. connnnFNTS; STATE OF Miti'+;' i4 DEPARTPIEHT OF NEALTH ABhHUONED WELL RECORD l. i0[A1[2n Oi vELI . MINNESOTA N0. H? E ? a N o no n e blant .n? co??iy x,m. DAKOTA i ro.?m?o xaK ta.?:m o xume aange nuaev sect+am xa. r,,caon <. WELL DEPTH (conpiecea) o.te seaiee EAGAN M E '' I, °' h 27 s' 23 Yr 12 SESENW 106 `t' Y 2'7 992 ? Nemerical 5[reet REdress ana Cltr o1 Vell 1o4t1on or Ofsbnce lrow RwE S. O0.ILLING NETN00 (i( tnavn) [n[erseceton ?Cable toal 10 Reverse 7[? ONven 10[] Ouq 3325 WREN LANE tpxonoYrtcd 50 ur eQeored tU Sho. eucc loutlm n! .m)l 70 RoLary 60 Jetted fQ Foyer 0.uger lfn uct7on 9r1d r1th 'T•) N Sket<h me 01 r ll l H p e au On N C? a !' H Q 6. OBSTRULtI0N5 4eli aEStrueted Q Yel Me _ i. _ ._. . ? OOttrutt lans mored Te ? No I/ a6strueHans oniroa te ? •.1 R renoveE, mnta<[ MOH M E w?Na l0o, . betorc sulinq. . : . r L USE w. ?DoweHC 4C] MonltoHnq 80 1kst Laao ? : • I 2[] [rrigaHOn So VubHc 9o Industry ' ' L 30 iest Mell 6[3 XuaiNpsl 100 tomnerelal S 7[]A7rCOndlHOniny 310 2. i0.0iEATT aVNEB'S NAME WIHnq Addreis If dlHerent than B. (ASIX6(5) GEORGE orooerty eeeress inefcated aoove JK elaek ?inreaeee 70 SCOTT 3325 WREN LANE ?WI,, ?Ve1eed EAGAN ? HN. 55121 3p vtestte 60 suinte:: steet xaaoxess or L FORMfION LOG COIOR f0A1NT[ON iROM TO 4 t?. eo 10 1 re, . If noe tnovn, InClcate formatfon log froA new well or nearEy weil. In, !o /t. SANDY CLAY ROWN 0 33 9. SLREEM XScreenee well trol{.] L tt. Ie INE SAND ROWN 33 65 , . 't. (1! ? on. xale tram tt, te Ynwn) _ _ AHD GRAVEL ROWN 65 75 20. STATIC VAiER LEYEL CLAY,ROCKS ROWN 75 gs ar +t.eelow ?ebove iand ur ace Oote lkesureE C_ 9 7_ O 9 C LAY RAY 8 5 101 11, yELLHEAO [011VLE7IOM LAY,GRAVEL RAY 101 136 1? Pltless REaDter 40 vouoe euried Basement o/iset ? ANDROCK RAY 327 347 w•li o+t 16. REMARKS, ELEYAiIOM, SOURCE Of OAiA - LASIXGS NEXOVED. USING$ PERfOMTED, ETC. lt. GROUTING INFONNTION EOLOGY WRS TAKEN FROH THE WELL AT: X xoc eemme tp eeneomu. U 7 BAGS 6rout MeteriaPORTLAND f406 tS URF..c. yez 55 LONE OAK DRIVE, EAGAN, MN. . NEAT GROUT ATER LEVEL IN THE ABOVE WELL: 130' -- ATE WATER LEVEL WAS TAKEN: 7-21-89 13. NEAREST SOII0.CE5 OF COXTAMIMIIiION r. het N_ elnctianCTTYSRWF.R rype Nell d7sln/ected bePore faUnq7 xYes 11. VUM7 [:] Remrld ?Q Not YreSent r l ?{{ Submerslbie 3EI L.S. Turbine SO Reciprocacing TyOe: /x 2[] Jet 1C] CenlrHUqal 60 15. EIISTING YELLS (Ylnse aketen lou[bns of abaedoned ana ??fm act1re .relle 1n tensrks fecHOn or on Oetk.) OMer nnuae! "it(s) en pro"rty7 [3 Yes He AbandOn d P T : E] e ern.nent 0 emppqry E] p ealeE SEALED 17 YATEP WELL [ONTRA[TORS CENTIFICAitON TMS uetl was seelee unUer mr lur7sdlction ane tMS revo•t is true to tht Eest ef my knOrletlga aoa eeiiet. cordi A t MN S R E- c ng o tate egulations 4op 1568??«lX1???f'5?? „ST. N.W. ii«?s? xe. na IV?R?HN.55330 427-6100 . FF?115 siynae -' e. ?.?..-._c,ce -28-92 STF.VF. T. ?•?:. pfilCiAL ngaNppNEO VEII 4ECON0 IMq Oe meE fo, GroOe.ty Tr.nster) MoM o Dr111er rrrcMrnwr: rru wtra naxn ,- KEVIN HOPPE 03,31!92 11rM Lo<OTfa CQ_N4Y-IaIF5IFRPI SF_P!. CTR. r Ordinance No. 114: W[I.I. qNn WA7ER SUPPLY MANAGEMENT MUNICIPAI. NOTICE OF WEI.L PEFtMIT APPLICAI'ION 001 bou DAKOTA COUNTY ENVIRONM[NTAL MANAGEMFNT DF_PAR7MENT WATER ANI7 {1AND MAfdAGEMEfdT 8 EC710N 14955 GalAxie Rvenue West, Appto Vailay, MN 66124 Telephone (812) $91a011 Pacsfmlle (612) 881-7031 pATE: 3' 3( - CV;L 71ME: TO: 7-'nL,Pr 1- FROM: nM rM SENT: Fa?C Mall` Other REFEFiENCE: NOTICE: The Water nnd Land Maneg0ment Sect{on Df the Dakota County Envitonmental Management Department has receNed the fellowtng permit application(s) for the well(s) doscribed. if you require further review of this apPfication(s) or it you tiave any questions ar concems aboid lt, contnei the Fnvironmr.ntal SpecinlisT Usted ahnve or our office at telephone (612) 891-7011. if t17ere is nv response irom your office within 24.hc_tLis (excluding weekends arid holidays), Wnter and Land Managem9nt siaff will assume that you liave no obJections issuance of the permit(s). Please note that permit issuance !s alweys rnndilioned ai the per.mit appl!conYs obselvance ot and comp}lanae wlth sli applicable laws and codes. A copy of the well permit(s) will be forwarded to your once when oompletad. . bESCRfPTION: PRQPFftI'`f:OWNER SfCN"to/j WFl I In I10fomnq LOCATION Of VJELL(A): ARDfiL85 1ClI.L KPe SFree.F , PUBLIC 11?ND SUftVEY COORDIIJ 7ES; OF OF F ,. a] N., R.? W., MUNICIPAUTY; _ PROPERTY ID NO, Ja qT7s ose)F ? WEIL CONTRACTOR: _ ??, ?.So nsucENSE No: a?s?o APPLICATIONRECEIVED SUBCONTRACTEDTO:.__ PERMIT 7YPE:N[W CONSTRUCTION R[CONSTRUCTION 17EPAIR(NoPormltReqvirecR PERMANEN7SE.4LIN(i/ AN t AL AINTENANCE: TEMPOR`ATYIrApPINCa_ RF.(%LAIMED-tl?? RE(313TERFp•USE_ pRIP.1ARY VSE OF WEIL(S) n.+J.eSEC r- ? CASING DIAMETER INCIIES; LENGTH .._ ?? FEET; VJELI. DEPTHFFET; AGUIfER ,S[Sd,'xifc'IU COMPL[TEO:OPENHOLE_ 6CfiEEMED_,r: ANTIGIPATEp DRILLINGISEALING [,A'I'Epi Known)t 3-- S( _A o'A_ COMMENTS: >- . _ _... . , . . EAGFN TOWNSHIP 3795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PERt3IT FOR WATER SL+RVICE CONNECTION Date: Januarv 7,_1970 Billing Name: Arnulf Myklebye Owner• A. N{yklebye Number: 400 610 - Z-/¢' Site Addreas: 2997 Pilot Knob Road Billing Address 2997 Pilot Knob Road . Plumber: Weierke Trdnchir ig & Excavat.ing Location of Conaection Meter Size Connection Chg. 230,00 pd $/7/70 6 950973 Aect. Bep. 15.00 pd 1/7/70 ' ? Meter No. Permit Fee , ? ???o Meter 111 ,00 Reading Meter Dep. Meter Sealed: Yes_ Add'1 Chg. NO iTotal Chg. A .. n iAJ / Building is a: Residence XC Multiple Ho, Commercial Industrial Other Inspected hy Date Remarks: Sy: Chief Inspector In coasideration of the isaue aad delivery to me of the above permit, I hereby agree to do tte proposed work in accordance with the rulea and regulatioas of Bagan Towaship, Dakota Count , Mianesota. ? By: Weierk Trenching & Excavating Rosemount, Minn. 55068 Please notify the above office when ready for iaspection aad coanection. ,? ... y . I EAGljN 19DWNSHIP 3795 Filoe Knab Road St. Paul, Minnesota 55111 Telephone 454-5242 PERASIT FOR SEWER SERVICE CONNLCTION DATE• Sanuar.y 7, 1970 OWNER:A.rnulf Mvklebve NUMBEx 549 Address 2997 Pilot Knob Hoad (D IQ--Z4 I `, PLUMBER Roger Weierke Trenehing TYPE OF PIPE cast iron DESCRIPTION OF BUIIAING IndusCriall Commercial[ Residential I Multiple Dwelliag I No, of units xx Location of Connections: Connection Charge 200.OOd 1/7/70 - Acct. Dep+bsit 15.00 pd 1/7/70 Permit Fee y-Iena ? Street Repairs ToCal Iaspected by: Dare Remarks• Sy Chief Inspector In consideration of the iasue and delivery to me of the above pesmit, I hereby agree Co do the proposed work ia accordance with the rules and regulationa of Bagan Tocroship, Dakota CounCy, Minaesota ? $3• Weie e Trenchi & Filccavatin Rosemount, Minn. 55068 Pleaee notify when ready for.inspection and comaection and before any portion of the work is covered. CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Conshuation Raqyirements ? 3 registerod sile aurveys ? 2 copies of plans (induda beam & window sizes; poured fid. design; etc.) ? 7 energy calwlalians ? 3 copies M tree preservation plan it lot plapad aRer 7l1/93 required: _ Yes _ No DATE: Kwrcl, - z1 - 9 S' Cc DESCRIPTION OF WORK: STREET ADDRESS: LOT _t_ BLOCK SUBD./P.I.D. #: COST: /`a OC1o PROPERTY Name: .SckwKS OWNER uc. ""sr Street Address* City: CONTRACTOR s..,Q. Phone #: r Street Address: 18S7, -(1,,,,, 4,Ac License #? 040 ? ?.:_-`SSIo 8 _ State:.._.?,t _. Zip. ARCHITECT/ Company: ENGINEER Name: Phone M Registration #* Street Address• City: State: Zip: Sewer & water licensed plumber: Penalry applies when address change and lot change are requested once permit is issued. :•Etr; acknowledge that I have read this appliqtion and state that the appiicable State of Minnesota Statutes and City of Eagan Ordinances. ,/ Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes _ No -fi30?. ?p rad 1 3 Remodel/Reoair Reoviremenffi ? 2 apies oT plan ? 2 afte surveys (exterior add'Rions 8 dscks) ? 7 energy cakulaGOns for heated addRions /-A- qSL- 5G13 Phone #: w "' 12,V- T? _ a rl3 State: V??L MAR 2 8 1995 with all Tree Preservation Plan Received Yes No OFFICE USE ONLY if* ?•. BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish 0 02 SF Dwelling o 07 4-plex ? 12 Multi Repair/Rem. ? 17 Swim Pool 0 03 SF Addition o 08 8-plex 6W, 13 Garage/Accessory ? 20 Pubiic Facility 0 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous n 05 SF Misc. ? 10 _ plex o 15 Deck WORK TYPE 0"1 New o 33, Alterations ? 36 Move 0 32 Addition o 34 Repair o 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq.' ft. MC/WS System (Ailowable) Main IeVePsq. ft. City Water UBC Occupancy ? sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories ? sq, ft. Booster Pump Length " sq. ft.' Census Code. `138 Depth. ootprint sq. ft. `- SAC Code Census Bldg / Oensus Unit O APPROVALS ??. F Planning Building Engineering Variance ; Permit Fee . _ ?. . Valuation: $ Surcharge ? DQQ Plan Review / License MCNVS SAC City SAC water Conn. 30 x*ra x ly °161 aco Water Meter «- S?A3 l3 Acct. Deposit - 3, o o° S/W Permit SNVSurcharge Y>a° Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: % SAC SAC Units ., PLOT PLAN INSPECTION RECORD ; CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: LOT: 1 BLOCK: 2997 PIL07 KNOB RD SUSSEL CORP ZEHNpER ACRES (612) 645-0331 PERMIT SUBTYPE: TYPE OF WORK: GARAGE/ACCESSORY ? L NEW BUILDING 025313 04/03/95 ? REMARKS: A SEPARATE PERMIT IS REQUIRED FOR ANY ELECTRICAL WORK HOMEOWNER IS DOING THE CONCRETE SlA6 ? CI.TY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 PERMIT PERMIT TYPE: Permit Number: Date Issued: c;u3W BUILOING 025313 04/03j95 SITE ADDRESS: P.I.N.: 10-88800-010-00 2997 PILOT KNOB RD 10T: 1 BLOCK: ZEHNDER ACRES DESCRIPTION: Buiiding permit Type GARAGE/ACCESSORY Building Wor-k Type NEW ,- ? .. ^... ?jk? ..../• (..J . ?...? .._;?' . ) ll ' i ? . . ? `..d. a REMARKS: A SEPARATE PERMIT IS REQUIRED FOR ANY ELECTRICAL WORK A H-6 P4E$kvi.-cRzS--B-B-F?`rv^-TT F FCGO#Eit-E-T-E-SL "° - FEE SUMMARY: VALUATION $17>000 Base Fee $180.00 Plan Review $117.00 Surcharge $8.50 Total Fee $305.50 CONTRACTOR: - Applicant - ST. I.IC. OWNER: SUSSEL CORP 16450331 0001934 OSLAND JAMES 1852 COMO AVE 2997 PILOT KNOB RO ST PAUL MN 55108 EAGAN MN (612) 645-0331 (612)725-2000 I hereby acknowledge that I have read this information is correct and agree to camply ? Statutes end Gity of Eagan Ordinances. ? ,• PPLICA /PERMITEE SIGNATURE application and state that tFie with all agplicable State of Mn. ? ISSUEO BV: SIGNATURE INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: B U I L D I N G 3830 Pilot Knob Road Permit Number: 025914 Eagan, Minnesota 55122-1897 Date Issued: 06 J 26 / 9 5 (612) 681-4675 SITEADDRESS: P•I•N.: 10-888ee-01e-ee APPLICANT: LOT: 1 BLOCK: 2997 PTLOT KNp6 Rp ACTION SIDING & ROOFING ZEHNDER ACRES (612) 457-2642 , . ? PERMIT SUBTYPE: TYPE OF WORK: SF (MISC.) REPAIR DESCRIPTION (ROOFIN6) ? CITY OF EAGAN •'383016i1ot Knob Road Eagan, Minnesota 55722-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-88800-010-00 PERMIT PERMIT TYPE: Permit Number: Date Issued: 2997 PILOT KNOB RD LOT: 1 BLOCK: ZEHNOER ACRES a-4433? BUILDIN6 025914 06/26J95 DESCRIPTION: (ROOFING) Btiildin}-Permit Type SF (MISC.) Euilding Wo,rk 7ype REPAIR -? ? . REMARKS FEE SUMMARY: VALUATItlN Base Fee 5urcharge Total Fee $74.75 $1.50 $76.25 $3,800 CONTRACTOR: - Applicant - sT. Lzc. OWNER: ACTIDN SIDIN6 & ROOFING 14572642 0005421 OSLAND JIM 215 2ND AVE S 2997 PILOT KNOB RD S ST PAUI MN 55075 EAGAN MN (612) 457-2642 (612)452-8633 I hereby acknowledge that I have read this application and state that the 3nfiormation is eorrect and agree to camply with all appkicabJe State of Mn. Statutes a d City of Eagan Ordinances. ? I /P MIT FPIAPtf ISSUED 51 TU Jc?? l.?l? CITY OF EAGAN 3830 PILOT KNOB RD - 55122 ,?¦'?•? 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681 -4675 New Construetion Reaufromenffi RemodeUReoair Reouirements ? 3 regiatered ake surveys ? 2 wpies of plan ? 2 copies ot plana (inGude beam 8 wiiMow sizes; poured fid. Eesign; etcJ ? 2 atte surveys (exterior addkions 6 dedcs) ? 1 enerpy celculadmis ? 1 energy eelculetlons for heated additlons ? 3 copies of tree pieservatlon plan if lot plaped after 711/93 required: _ Yes _ No DATE: IS -.-,2 6-9 <- CONSTRUCTION COST: DESCRIPTION OF WORK: -/Fll II??'/aC'/T STREET ADDRESS: LOT ? BLOCK 2c?c?] - Tl L oT ?rz 13 00 SUBD./P.I.D. #: ? 41111 Pp D,Y. Idl,101? PROPERTY Name: D S L w h U ? iLi, Phone #: /-/Sa -,9-633 OWNER '""' StreetAddress• P `"°' /L o? )?o eI3 1t ? City: ?vState: V 12/ Zip: CONTRACTOR Company: Phone #: ?16-7-06 1-i2 Street Address: License #: a o o-S-0a 1 City: State: Wti Zip• ARCHITECTI Company: Phone #- ENGINEER Name: Registration #- Street Address, City: Sewer 8 water licensed plumber: change are requested once permit is issued. I hereby acknowledge that i have read this appiication and state that the epplicable State of Minnesota 5tatutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY State: Zip: Penatty applies when address change and lot to comply with all Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received Yes No OFFICE USE ONLY ..t . Y BUILDING PERMIT TYPE n 01 Foundation o 06 Dupisx o 11 Apt./Lodging ? 16 Basement Finish ? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool 0 03 SF Addition o 08 8-plex ? 13 Garage/Accessory o 20 Public Facility 0 04 SF Porch o 09 12-plex o 14 Fireplace ? 21 Miscellaneous 0 05 SF Misc. 0 10 _-plex o 15 Deck WORK TYPE 0 31 New o 33 Alterations ? 36 Move 0 32 Addition o 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actuai) Basement sq. ft. MC/WS System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. Depth Footprint sq. ft. SAC Code Census Bldg Census Unit APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ PjJ "? Surcharge Pian Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: % SAC SAC Units r EAGAN TOWNSHIP BUILDING PERMIT o wae: .... . .. .. ........... . . . ..---? ...----------- -........ --- . ... ...... . ...... ....... ,(?? ?? Address lPresaxil -- ....?.?.?......?...... ?........1..`...""'_,:'_ .......... .. Builder ....._. ..!r....' .............°°-----------...-- .... Address .................................... ................. -.................................... N° 2598 Eegax Township Town Hall aetB _..!rli':......'./--• .................. Stosiea4 To Be Used For Fron! Depth Heigh! Est. Cos! ermit Fae Remazks ?1 s -/M ?/d;D Ve, or / This permit does aot authorise the use of sireeffi, roeds, elleys or sidewalks nor does f3 glve !6e ownes os his agent the righ! !o creake any siluaSion whieh is a nuisance or which presenls a hazerd !o the health, safety, coavenienee and ganesal welfare !o anyone in the communifp. THIS PERMIT MUST BE NEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. 1'his is ta cerlifp, thal----- 1'?-`---?-y. [?-'-,-?-,yl .... . ...... . . . ...---.has permisaion Yo arec! a................?.,r{J{,._..__..... ?................... _uPoa the abave described premise subje?'! !o !he rovisiona of the Buildin4 Ordinanee for Eaga Tif? wnsffip adopled April Il, 18b5. . .....................-"_...1?!Q?---..............."-'. Per ...............,..........!.Y??!?c "'--........"""'... ....._p".... ... ........................ S Chair n of Tnwn Boar¢ Bvilding Ins eclor ,& ? s 0624i92 10:17 DFiKOTR CIX14T!-kESTERhI SERV. CTR. 001 C*' Ordinance No. i 14: WELL AIVD WATETi SUPPLY MANAGEMENT MUNICIPAL NQTICE OF WELL PERMIT APPI.ICATION DAKpTA COUN7Y ENVIRDNMENTAL MANAGEMENT DEpARTMENT WATER ANp LAND MAPlAGEMENF SECTION 14955 Qal9xie Avenue West, Apple Valley, MN 55124 Telephone (812) 891-7011 racelmqe (612) 881-7031 DATE: G(Z5 /(?? 7lME: an SENT:• qg?- MaiiOthar ro: ? FR01111: RF_FERENCE: U-ky4t ' bN r 1dOTICE: T.he Water and Land Management 5eetion of the Dakota County Environmental Managemerrt Departmerit has receNed the following permit appliaation(s) for the well(s) doscribed. it you require further review of ttlis application(s) ar if you have any questlons or concerns about It, aantaot the Errvlronmerriaf 5pecialist Iisted abova or aur office at telephone (612) 881-701 i. If ihera is no response from your oftloe Wfthin 24 hgurs (exGutling weeKends antl holidays , Watex and Land Management staff will asauma fhet you have na ObjeCtions issuance of the permit(s?. Please note that permit issuance is always condftloned on the permtt appliCariYs abservance of and compliance with aii applicabla laws and codes, A copy oi che wen permit(s) will be forwardetl to your afficv wnen campieted. DESCRlF'TION: ? ----- PRQPER7Y:qWNER WkII,Lp(DiffarorV tOCAT10N OF WELL{S); AUpRES5 ` ?f;&'Idr /? . PuBiJCtANpBV CODqDINA7E8?_QF??OF_O?, t5ECTIO _-.7.2.ZN., R W., MUNICIPAUTY: PRPPERTYlD N0. WELL CONTRACTOR: ? A llCENSE fdO.CgaZ-- APpUCA'110N RECEIVEb e_ fj c2o 2 6UBCONTRACT6D TO: PERM17 fiYPE:NEYY CONSTpiJCT1pN pECONSTRUCTION REpAIRQJoParmARequired) PERNtANENTBEALINti L^-AryNUALMAINTENANCE; TEMPO?APPIfdG REClA1MED-USE - ...... .. REGISTEREb-USE? pRIMARY USE OF WELL(S) CAgINP DIAMMR 40 INC:HES; LENGTH FEE7; WEI.i. DEPTH .Z 7eZ FEET; AdUIFER CoMPLEiEO: OPEN HOLE- SCREEIVEp L.----; ANTICIPATED ORIU.INGlSEAUNG 6ATEp! NnovrN; GqMMEN"fS: s RECEIb": D ; U I 07/06i92 14:07 DF/COTfi CIXNTY-41ESTEFcN SE12lU. CTR. 001 i.! 6 5992 WEI.L MUNICIPAL Ordinance No. 114: WATER SUPPLY MANAGEMENT OF WELL PERMIT APPLICATION DAKOTA COUNTY EI?JVIRONMEN7AL MANACiEMENT DEPARTMENT WA7ER A'ND LAND MANAGEMENT SECTION 14955 Galaxi,e Avenue West, Apple Valley, MN 55124 ;Telephone (612) 891-7011 i Facsimila (?12) 891-7031 DATE: 7!2/5Z 71ME: ;___,4PM SENT,A_ Metl TO: FRO REFERENCE: y'Z - Other NOTICE: Tha Water and Lsnd ! Management Section of the DaKota County Environmerital Management Department has recetved the following: permit applicatlon(s) for the welf(s) described. If you require funher review of this application(s) or d you heve any quesdons or concems about it, contact the Environmental Specielist Iisted above or our oflice et telephone (612) 891-7011. If there is no rasponse from your office whhln a ho s(exdudfng weekends and holidays , Water and Land Managem2nt staH will assums that you have no objecHons Issuance of the parmit(s;. Please note that parmlt Issuance is always condlcioned on tne permit appiiconYs obasrvanoo ot and complienoe witn a11 appIicable lews and codes. A copy of Yhe weli permit(s) wlll be forWarded to youf offlce when completed. DESCRtPTIpN: ' PROPERTY:OWNER WELL(nqtrorsnq LOCATION OF WELL(S): qDORESS rkQ97 -A/L,Qj' O)46 _ PUBLIC LAND SURVEY COOit'DIAAr( : F OF OF OF, MUNICIPAUTY: VYEIL GON7RAG7qR! LIC6NSfi NO.C420Q? APPUCA710NREGENED SIJBCONTRACTED TO: PERMIT lYPE:NEW CONSTRUCTION ' RECOMSTRUCTION REPAIRtNoPormhRsqWrxq PERMANENT 6EALING ?ANaDAL MAIMTENANCE; TEMPO?APpINO RECWMED-USE RE619TERED•USE -MMAiiY U6E OF WELL(S) - CAStNQOIAMETER &I(_INCHES;LENOll-I FEEf;WELLDEPTH FEET; AOUIFER ??----? ANTICIPATED DRILLIfJG/GEALIN6 DATE(M Kn": COMMENTS: COMPLEfEP:OPENHOLE- SCREENED4? ? y8' io?? /i/n ? rn ? ?---- .? ?s ? ? ? , / ? ? MASTER CARD - v 0 STRUCTURE AND LAND USED AS ? c Permit No. Issued Issued To Coniractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK weu ' ELECTRICAL HEATING GAS INSTALLING SANITARY SEWER OTHER O7HER 11 • Items Approved (Initial) Date Remarks Distance From Well FOOTI NG $EPTIC FOUNDATION CESSPOOL FRAMING ? a• TILE fIELD FT. FINAL ELECTRICAL • HEATING ? DEPTH OF WELL GA$ WSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER Violations Noted on Back COMMENTS: . COMPLIANCE INSPECTION REPORTS TO BE USED ONIY IN EVENT OF OBSERVED VIOLATIONS r 1 L J PERMIT NO. CONDI710N5 OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE OBSERVED. ? ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. DATE OF INSPECTION ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ? NON-COMPLIANCE. BUILDER DOES NOT INTEND TO COMPLY. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. ITEMIZED AND DESCRIBED AS FOLlOWS: ? REINSPECTION REQUIRED R DATE OF REINSPECTION CE RTI FICATI ON - I certify that 1 have carefully inspected the above in which I have no interest preunt or prospective, and that I have reported herein all significant conditions o6served to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site imprwements relating to the property inspected. F ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPEGTOR DATE ? City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 2997 Pilot Knob Rd Lot: 001 Block: 000 PID:10- 88800 - 010 -00 Use: Description: Sub Type: e- Fireplace Work Type: Gas Insert Description: Census Code: 434 - Occupancy: Zoning: Square Feet: 0 Comments: Fee Summary: Valuation: 3,000.00 Contractor: Fireside Hearth & Home 20802 Kensington Blvd Lakeville MN 55044 (952) 985 -6675 Addition: Zehnder Acres Chimney /flue must be inspected prior to concealing. Smoke detectors are required in all sleeping rooms prior to final inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required. Battery operated types are acceptable if the wall/ceiling finish (i.e. sheetrock) has to be removed to install a smoke detector. Andrew Hoffman BL - Base Fee $3K Surcharge - Based on Valuation $3K Total: $90.00 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 PERMIT City of Eaan - Applicant - Construction Type: Owner: James E Osland 2997 Pilot Knob Rd Eagan MN 55121 Permit Type: Permit Number: Date Issued: Permit Category: $88.50 0801.4085 $1.50 9001.2195 Issued By: Signature Building EA087856 12/23/2008 ePermit îú ÿþ þýý üû úûú ùýýúìç ï äää þýö ýüûúùø÷ö õ üúùø ÷ ÷ö õ ôöõóøò ñü ü ðìüøù ïÿ ýîü òø ëò ò îü ò û ò êé ÿööøÿ þé é òÿ ý øêé é øé ê ûòè îü ûùö ÿéòùò ê íæðåæääêäêä õù ýü æêãêã çüðþê ôó öòñ øø óö Üò ì ãüùó÷ ããåûó ó ë ôð ÿ ô àâßâ ûùöÿë øø é ò ÿ òøùöøøûý é ýü ùé ÿì ê øøõ òýÿü üùýÿü PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA154439 Date Issued:03/22/2019 Permit Category:ePermit Site Address: 2997 Pilot Knob Rd Lot:001 Block: 000 Addition: Zehnder Acres PID:10-88800-00-010 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: 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. Contractor:Owner:- Applicant - James E Osland 2997 Pilot Knob Rd Eagan MN 55121 Air Mechanical 16411 Aberdeen St NE Ham Lake MN 55304 (763) 434-7747 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA170155 Date Issued:06/22/2021 Permit Category:ePermit Site Address: 2997 Pilot Knob Rd Lot:001 Block: 000 Addition: Zehnder Acres PID:10-88800-00-010 Use: Description: Sub Type:Fireplace Work Type:Wood Burning Fireplace Description: Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to concealing. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 3,000.00 Fee Summary:BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 $90.00 Total: 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. Contractor:Owner:- Applicant - James E & Margaret A Osland 2997 Pilot Knob Rd Saint Paul MN 55121--115 Fireside Hearth & Home 2700 Fairview Ave N Roseville MN 55113 (651) 633-2561 Applicant/Permitee: Signature Issued By: Signature