4605 Pilot Knob RdCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19
AMOUNT $ I
?? `? ?J!d' y-t E
DOLLARS
7oo
? CASH ? CHECK
FOR
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN Remarks
Addition Thrin View Manor Lot ? Blk 1 Parcel 10 $200 020 Ol ?
owner ? Street 4605 Pilot Knob xd. state E anMN 551 ?"'? *
?.r2
Improvement Date Amount Annual Years Payment Receipt ate
STREET SURF.
STREET RESTOR.
GRADING
t•
SAN SEW TRUNK ?
* SEWER LATERAL y1 .?
WATERMAIN
* WATERLATERAL 1981
WATER AREA r2- 1980 O 5.67 IS
STORM SEW TRK D 1985 711.0 47.40 1
STORM SEW LAT '
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK ?
CITY OF EAGAN Remarks
Addition Mn View Manor Lot 2 eik 1
owner Street 4605 Pi1ot Kriob Rd.
L.Ct
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1 6 195.00 13.00 1
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA 1980 280.00 1$.67 I5
STORM SEW TRK o 1985 711.00 47.40 19
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
8UILDING PER.
SAC
PARK
CITY GF EI?GAN SEWER SERVICE PERMIT
3795 Pilot Keob Road PERMIT NO.:
Eogan, MN 55122 DATE:
Zoning: No. of Units:
awner: -
Address:
Site Address:
Plumber: ----
I egree fo wn?ply wirh Hw Cify of Eagon Connection Gharge:
Ordinances. Account Deposit:
Permit Fee:
Surtharge:
By Misc. Charges:
Dote of Insp.: Total:
Insp.. Date Paid:
. r'
cirr o."• EAGAN WATER SERVICE PERMIT
3795 Pi1ort Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
pwner: - -
Address: ? ? ? • '?
1 Ct
Site Addre...,. _
Plumber.
Meter No.: - Connection Charge:
Size: -- Account Deposit:
i Reader No.: Permit Fee: 1 agree to eomply wkh the City of Eagon Surcharge: '?•
Ordinonoes. Misc. Charges:
Total: , . . ,
... ,
BY Date Paid:
Dote of Insp.: Insp.:
oWna:
Address (presen\?-.
Builder
Address
EAGAlel TOV!/NS HI P
QUIe nINr_ o?RMI-r
DESCRIPTION
N° 424
Eagan Towaship Towa Hall
Dale ----
Siories To Be Used Fox Froni Depth Heigh! Esi. Cosf PermiY Fee Rem rks
' - LOCATION - -? /1
axreen noaa or omer yescnnnon ox i..acanon i i.o: i niocx I AQalIlOI1 OI iracr
, ! /? _ dUo? ' /r/ ?
This pe i?dces aot sufhorise the u=_e eis, road , eps or sidewalks nor does it qive the ownes or bis agenl
the righ!!o ereate aap siluation which is a nuisanae or wk:ich presenYs a hazard !o the health, safeiy, coavenienee aad
general welfare !o anyone in the communify.
lp? ?? P
THIS PERMIT MUST SE^i{^FPT O_ . . T?EMI/,S£ WHILE THE WORS IS IN PROGR
This is !o ceriif !hel... ??iP:?y? _.has permiss}'Q n !o exeot a..._.. .. ?......_ ............." ".......... u on
the above dESCxibed premiae subjec! Eo fhe prooisions'? fhe BuildinOrdin for Ea4ari Toy? ' '!? April 11,
1955. / ?fJ?
Chairmaa of Town
Ee4GABvl TOW!`olSl-IIP N,.; 29 0
B1.91LDBi?IG PE12N9i'r
OwneT ......r........./!._......_.????.?...."-'Q?? / Eagan Township
Address (presen!) _... .../.?-?-_.'?`:?I.?C.{?"?:. Town Hell
.
Builder ......... ........ - ' .?[tC.KQ . ........... -............ .._.._ ,.•
D .. ??(..1..? ...............
Address ..... ----.................................... ..._..--------------....__......._..
DESCRIPTION
Stories To Be Used For Fron! Depih Height Esi. Cos! IPermii Fee Remarka
i ??G?%?v 0?? _ ?am)?l ??/1??,26
/ll /X LOCATION 1 ? _
or
or
This pes does not aulhasise f? ise of sireefs, roads, alleys ox sidewalks nar daes it give the owner or his agenf
the righ o creale any sifuafioa which is a nuisanee or which presenfs a hazard !o the healih, safefy, convenience aad
general welfare fo anyone in the communiiy.
THIS PERMIT MUST 8ggEP O a PR kIISE WHILE THE WOAI{ IS IN FRO p 4
This is !o ceriify, ihai...(..?_k7?...--u?'--?-£-'---..-.-'----....has permission fo erecl a.1?.-_------ ----"----- -"' ------------------- upon
io, s4-Ydihe provisions of the Building Ordinance for Eagan nship !ed April 11,
the above deseribed premise sub'
1955.
. ......----.........
....... .........- -- . . - f- ? ------ .. .---.... Per ._......:--------------...._..__ ...--------...._`-------"
- -`
Chairman of To oard Building Inspecfor
?/?y/n /
P 115 4 5 ?
Request Date Fre No.
/
/? • Rough?in Inspaction
Re
quired?
? Heetly Now kWill NoHy Inspector
6
? ?
Yes No When fleady?
Itg licensed con[ractor ? owner hereby request inspection of above electriral work at:
Job AtlEress (Streel, Bav a Rou1e No.) Ciry
-4(=05 A R«+c. &Cv,u
Secibn No. Township Name or No. Rarge No. CouMy
OQWIM.
OccupeM (PRINT) Phone No.
NeaL-Ci+nlv-s A54-1`t'l7
Pavar Suvpier ntltlresa
??
+?'? ?1'?i71hC16CfF.IC p3C0Z='msC. W. IF62M1 'pnA1'"1.1.
Elec4ical ConVactor (COmpeny Name) ConVaclor§ Licerree No.
IYIm- E '4MS0 -CX1
Mailiiq Adtlreas (COniraclar or Owner Malting Insfalletbn)
MIS CbQ)o QoA Ep[3AN Mu. S51ZI
AutMnzed ' re(Cwnr ner Making Installetion) Phona NumOar
-IJG_--Ia \ 1G
WNNESOTA STATE BOAND OF ELECTF THIS INSPECTION REWEST WILL NOf
GriggtMMway Bltlg. - Rdom S-173 BE ACCEP'fE0 BY THE STATE BOARO
1821 Univoraity Ave., SL Paul, MN 55104 UNLES3 PROPER INSPECTION FEE IS
Plqnre (812) 692-0800 ENCLOSED.
??/?[? REQUEST FOR ELECTRICAL INSPECTION
? See inslruclbns tor completing ihis form on back ot yellow copy.
P ,..1-18'4 5, "X" Below'Work G'bvered by This Request
' E&W001-0]
J iIL?_S
N9% Adtl Re . TypeotBUiltling AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric HeaNng
Apt. Building Dryer Olher (Specify)
Comm.llndustrial Furnace
Farm Air Contlilioner
Other (specify) Conrcsctor§ Pemarks: IU=?? 1313epeer,
.QCWD Me-"M_SCCY.8T
? us
Compute Inspection Fee Below: nNO wtrts .
# Other Fee # ServiceEntranceSize Fee # CircuitsiFeetlers Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Trensformers Above 200 _ Amps Above 100 ? Amps
Signs Inspeclor§ Use Onry: 7p7AL
Irrigation Booms j J?U 9:7
Special Inspection ?
Alarm/Communication
Other Fee
I, the Electrical Inspector, hereby
if
h Rouyn-in oa+?
cert
y t
at the above inspection has
been made. F;,,,l
OFFICE USE ONLY
ThIS requeat voitl 18 monihs Imm
?/ii/sy ??-
? 43476? / ? ? - ?
Request Dete '
.? Fire No. F ghin Inspeclion
Fequiratl?
? Reatly Now?'?Vill Notily Inapecior
R
d
?
W?
Ip Q ?Yes en
ea
y
Iicensed contractor ? owner hereGy request inspection of above electrical work at:
bb Adtlre3s SVee6 Box a Roule No. City
o,
Section Na. Twm4hip Wme or No. Re No. Cau
"DA xo r?
OccupaM(PFINn Plqna No.
Power ier .
Suppl,A o-TA- AOdress
Electn eNac[or (Canpany Neme)
r-o ev-
/?c?r? c
(('o • ContractorB" ;anse No.
C? y/?3 /
Maifing Addreas (COnVxlor or r Malarig I stellation)
? ??
?6. /np/n A"??7
/'? / /'`?l
Auttrorized5' ure(Cpfredor Maki I tallafion
. Phtne Number
?
MINNESOTA STATE BOARD OF ELECfqICITV THIS INSPECTION REQUEST WILL NOT
Gtlggs-Mitlwey Bltlg. - Boom S173 BE ACCEPrEU BY THE STATE BOARD
1827 Unlverclry Ave., SL Paul, MN 55101 UNLESS PROPER INSPECrION FEE IS
Phom (812) 6412-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION . Ee-00001-07
_?-uee biltructions br completing Ihis (om on back oi yellow Copy.
43 ? 7 'X" Below Work Covered by This Request
ew ,Adtl. Rep. TypeoiBUilding AppliancesWired EquipmeMWiretl
Home Range Temporery Service
Duplex Water Heater Electric Heatirg
Apt. Buildirg Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specify) Contrac[or§ Remarks: T
Q wer
?f
Compute Inspection Fee Below: /1iLrY' / N C.QAA' vAl
# Other Fea # ServiceEnlranceSize Fae # CircuiislFeeders Fee
Swimming Pool 0 to 200 Amps D 70 100 Amps
Transformers Above 200 _ Amps Amps
Signs Inspector5 Use Onry: ,r TOTAL
Irrigation Booms
Special Inspeaion
Alerm/Communicafion
Other Fee
I, the Electrical Inspector, hereby
cert'rfythat the above inspection has
been made. Rough-in oaie
Finei
"
OFFICE USE ONLY -
This request voitl 18 moMhs from
WAI6'3? Dr HEF1FiIMC,
R:Q[J!'aST FOF. CTILITY IMII1R9NEMITS
21-4a 1tEreby rec,uest of the City Council. City oF Eagan,
?_3.?enescW, ut.i.lity fr,pxovements on and over pzcperty orao3 by L10/113 .s
;o7.lc:s: (Mer*..;en lype of impmnemPnt, e.g. water, aanitary sexvr, etc.)
_ SEWER AND WA7'ER LATERAL5 L.ot 1, 6t?k I 1%aj„ v; e.s Uannr -
'.aie loration of ssaid util3ty impzovements ehall be qenerulj a3 ,`.ci.?•?-
110 feet at 9.65 FF for watermain = $1061.50
110 feet at 11.50 FF for sawer lateral m 1265.00
TOTAL ASSESSMENT 2326.50
Spread far 10 years at 8$ interest
I/sl.: Lereby wmive notice of any and all hearings neceseary Cor Clze
instaila.tl.on of eaid 3.*ap!rov¢mente and further oonsFnt to any asae_s:?•r`s
necF.saa*_ily levied by tIis City of Eage.tt for such impror-ementm.
I/tTe furthsr ayzee ta gzant to the City of Eagan any easem:ats ^:.:as-
sary for the inctallation of such improvementa.
It is further tmderstood that this request shall be reviewe3 t+y th2
CiL-p Council of The City of Eagan or ita aqent and 2/We will be g-'ven
reaecaable notice as to whether this request is possible under psescnt
utility plarning as to timinq,
Dated: Janusry 15, 1980
locatinn, et . ?
N
' $1Cf.18tiiLH
&iiclress
F.eTaes` accegted
C'?ty of Eagan
Raquest referred to City Administrator:
Date
d
Copies: 1. City Administrator
2. Applicant
lio I78200 Ioza 10i 11
41)
OUNTY NAME / DESCRIPTION AND DELINQUENT TAX
?Fpp? yy PROPERTY OESCI
'1SIONr._ - . y . .___ ..,_.. ?..-.?:..:-.v.._._.
N TONNSHIP 196U ?NIN VIEW MaNOR
..«„e.tir« nLl OF L0T 1 8LK
2 I4L1 IpF F
5 u-b? j +o
e s,rn n f- _Qa ?'ce I ?ri C*y
LJ M uP LQ '7
? /?'- 4 ?'
,
oF czaaan
3830 PILOT KNOB ROAD
EA6AN, MINNESOTA 55144-1897
PHONE (612) 454-8100
FAX: (612) 454-8363
August 24, 1990
MR AND MRS NEIL F COATES
4605 PILOT KNOB ROAD
EAGAN MN 55122
THOMASEGAN
Mayor
DAVID K. Gl15TAF50N
PAMELA MdREA
TIM PAWLENIY
THEODORE WACHiER
Couricil Memtr_rs
THOtiLA5 HEDGES
CiN Adminisba[or
EUGENE VAN OVERBEKE
Ciry Clerk
Re: senior Citiaen special Aasessment Deferment
Parcei No. 10-78200-020-01
Tw:n V.'ew N(Unor
Dear Mr. & Mrs. Coates:
In official action of the City Council at its regular meeting held
August 21, 1990, the above referenced application was approved as
presented.
This information is being forwarded to the Dakota County Auditor
and will be reflected on all subsequent assessment searches as
senior citizen deferred assessments. Please note that under
certain conditions such as the sale, transfer, or subdivision of
all or any part of the property or loss of homestead status, the
deferment terminates and all amounts accumulated plus applicable
interest become due.
Please call if you have any questions regarding this matter.
Sincerely,
? 6E. . VanOverbeke
Finance Director/City Clerk
cc: Linda Fink, Accountant II
Deanna Kivi, Special Assessment Clerk
EJV/vmd
THE LONE OAK TREE.. .THE SYMBOL OF STRENGTH AND GROWfH IN OUR COMMUNIiY
Equal Opportuniry/Affirmative Action Employer
, APPLICATION AND AUTHORI2ATION FOR DELAYED PAYMENT OF TAX
ON SPECIAL ASSESShfENTS FOR SENIOR CITIZENS' HOMESTEAD
LAIVS 1974, CHAPTER 206
STATE OF MINNESOTA)
COUNTY OF DAKOTA )
-DATE Aigust u 19-2D-
T0: County Auditor, Dakota County, Minnesota
I I, the undersigned, declare under penalties af perjury:
That I reside at uFnS Pilot Knob Rnad, Eagan, MN .
That I am not less than 65 years of age an that the date of my birth is May 5 1921
That I am the owner of the property legally described as: Tvaib View Manor,
nii nf Lnt 1 Bl.r?ck 1& A1._ of Subi to Hwy Esmnt Parce, T_i y ap
, Property Identification No10-78200•-020-01.
That my interest in tfie ownership of the above property was aquired on October 7, 1958
19 and is as follows: '
1. Sole ownership (Enter Yes, if applicahle)
2. Joint tenancy, held with Neil Y Coates
3. OTHER undivided interest (Specify)
That on January 2, 19-io-or June 1, 19_fQ__I owned and occupied the above property as my
homestead and such occupancy hegan on December 3, 19 58
That the installments for improvements on the SPECIAL ASSESSP9ENT5 duly adopted in ordin-
ance by the dt k.e4l OF ? AS OF_4W.41 9 1960
which have been al?locat ?ed against the subject pro ty would create undueYpeisonal hard-
ship on my behalf and I respectfully request that payment be delayed and that such in-
stallmEnts be so deferred for the years 19 to
SIGNED:IzIlD.&",,J-
OWNER?? " ? SPDUSE
- - - - - - - - - - 1 ?
I, , Cierk of the OF
IN County, State of Minnesota, do hereby certify'that the application
of above named, has been duly reviewed and that '
in ac_erdance with c! minutes of official record in s d nhambers was duly :
APPROVED ? e!-86tF?&8 as of?vT??} '(. 191 ti.
That in accordance with approval granted, the SPECIAL ASSESSMENTS listed below on the
affiants suMject property levied for annual collection in the amounts and for the years
shown be so deferred with interest at the annual rate shown until such time as it is
deemed the applicant no longer qualifies or the property loses its eligibility.
ASSESSMENT D/P N0. TOTAL AMOUNT YEARS INTEREST RATE
Storm sewer lateral 2065
reet
2069
DATED 19_9Lq_
5937.50 10 9%
865.49 10 9%
(over)
SPECIAL ASSESSMENT SEARCH SUMMARY
AS OF: 08/13/1990
PROPERTY ID: 10-78200-020-01
S/A# ASSESSMENT DESCRIPT. YEAR TM RATE TOTAL ANN.PRIN. PAYOFF CD
100304 SAN SW TR 1975 15 8.0000 390.00 26.00 0.00
100422 WATER AREA 1979 15 8.0000 560.00 37.33 149.37
100463 S/W LATS 1980 10 8.0000 2336.50 233.65 0.00
100904 SSTRK384 1984 15 10.5000 1422.00 94.80 853.20
102068 SS 466 1990 10 9.0000 5937.50 593.75 5937.50
102069 ST 466?/? 1990 10 9.0000 865.49 86.54 865.49
?
? ?
------ SUNIMARRY OF VIED 11511.49 391.78 7805.56
****** 1990 P&I CERTIFIED 527.02
------ STJMMP.RY OF DEFERRED 0.00 0.00 0.00
------ SUMII4ARY OF PENDING 0.00 0.00 0.00
------ SUFII+iARY OF CLOSED 0.00
Press ENTER; or F1, F4, F5, F7, F8
?
? 4 ??4? DeparimenloftheTreasur I temalRevenueService {? OQ ?
?l
?
U.S.IndividuallncomeTaxReturn Up
o>
FortheyearJan-De<.31.1989.or otherlaxyearDeginning .1989.enain ,19 OMBNo.15450074
Label Your stnamean0imtial Lastname Yoursacialsecurity number
475 : 22 : 7472
U5e IR$ lahel.
Otherwise A
e If a loint retum. svouse's first name and initial Last name Spouse's social security numEer
,
pleaseprint
L
E .
473 : 18 : 5659
or type.
x Home aGtlress (numDer antl street). (II a P.O. 6ox, see page 7 of Instructions.) Apt. no.
For Privacy Act and
E Paperwork Reduction
R
E
City, town or post oHiw, state and ZIP cotle. (If a foreign atldress. see page 7.)
Act Notice, 52B
Instructions.
Presidential }{
Doyouwant$ltogotothisfund?. . . . . . . . . . . ves Note: Chetking "Yes"will
No notchangeyourtaxor
ElectianCampaign / If'ointreturn,does oursousewant$lto otothisfund?. ves X No re0uceyourre/untl.
1
Single
FilingStatus p Marriedfilingjointretum(evenitonlyonehadincome)
M
3 Married tiling separate retum. Enter spouse's mcial security no. a6ove and full name here.
Chetk onty
one box. 4 Head of household (with qualifying person). (See page 7 of Instructions.) H the qua lifying person is your thild but not
your dependent, enter child's name here.
Exemptions
(See
InStructions
on page 8.)
If more than 6
dependents,see
Instructions on
page 8.
Income
Please attach
Cnpy 8 of your
Forms W-2, WQG.
and W-2P here.
If you do not have
a W-2.see
page 6 of
Instructians.
?
Please
attach check
or money
order here.
Adjustments
to Income
(See
Instructions
on page 14.)
Adjusted
5 Qualifyingwidow(er) with dependent child (year spouse died ? 19 ). (See page 7 of
6a [? yourseH If someone (such as your parent) can claim you as a dependent on his or her tax
? return, tlo not check box 6a. But be sure to check the boz on line 33b on page 2. .
b [X Spouse . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c
Dependent5:
(1) Name (flrst. inlllal, and last name) (2) ChecF
if unGer
ag¢ 2 (3) If age 2 or older, 0ependenPs
ocial securitY
number
(4) Nelationshi0 (5) Na. oi monlhs
IiveO in your home
7
n 1989
? No. ol boces -
checked on 6a Z
and 66
No. of rour
children on 6c
who:
• lived with )rou _
• didn't live with
you dueto
d?wrre or
separation (see
page 9) -
No. af other
dependents on 6c -
0.dd numbers
entered on
lines above la
d If your child diddt tive with you but is claimed as your dependent under a pre1985 agreement, check here ? L
. . . . . . . . . . . . . . . . . .
e Totalnumberofexemptionsclaimed. .
.
2 7
) . . . . . . . . . . . . . . .
7 Wages, salaries, tips, etc. (attach Foim(s) W-
8a Taxableinterestincome(alsoaftachScheduleBi/over$400) $a
b Tax-exempt interest income (see page 10). DON'T include on line 8a 8b ?
400 9
9 Divitlend income (also attach Schedule B if over $
) -
e 11 of Instructions
k
h
t
a
f
f ld
..
rom wor
s
ee
on p
g
any,
30 Taxable refunds of state and local income tazes, i
11
11 Alimonyreceived . . . . . . . . . . . . . . . . . . . . . . . . .
12
12 8usiness income or (loss) (attach Schedule C) . . . . . . . . . . . . . . . .
13
13 Capitalgainor(loss)(attachSchedu/eD) . . . . . . . . . . . . . . . . .
14 Capital gain distributions not reported on line 13 (see page 11) .......... 14
.
15 Oth
i
l
) (
tt
h F
4797 15
) . . . . . . . . . . . . .
er ga
ns or (
osses
a
ac
orm
16a Total IRA distributions . 162 16b Taxable amount (see page 11) 16
17
T
t
l
i
d
iti 17a 592
10 -- 17bTaxableamount(seepage12) 1??
a
o
a
pens
ons an
annu
es .
18 Rents, royalties, partnerships, estates, trusts, eta (attach Schedvle E) ....... lE
19 Farm income or (loss) (attach Schedule F) . . . . . . . . . . . . . . . . . 1`
20 Unemployment compensation (insurance) (see page 13) . . . . . . . . . . . . Z?
121a I I 216 Taxable amount (see page 13)
it
21
S
i
l
b
fit 21
secur
s. .
a
oc
a
y
ene
22 Otherincome(listtypeandamount-seepagel3) ........................................... 2s
23 Add the amounts shown in the tar right column for lines 7 through 22 This is your tatal income ? 23
24 Your IRA dedudion, from applicable workshee[ on page 14 or 15 24
25 Spouse's IRA deduction, from applicable worksheet on page 14 or 15 ZS
26 Selfemployed health inwrance deduction, trom worksheet on page 15 26
27 Keogh retirement plan and self-employed SEP deduction .. 27
28 Penalty on early withdrawal of savings ........ 28
29 Alimony paid. a RecipienCs last name ?
and b social security number. .. 29
30
f[rB[t line JU IrOm line 23. ihi5 is your aajustea gross incame. rr rms urie ?n non ..m??
? 340 and a child lived with you, see "Eamed Income CrediY" pine 58) on page 20 0l 13,360
Insfructions. If vou want IRS to /ieure vour tax, see pa.2e 16 0/ the Instructions ....? 31 _
• Form 1040(1989) - Page 2
11 n-M s.,...,r- 11 i?n????rodo...«???,.,?oi 32 li -4R(1
TBJI
COIOPU•
tation __
33a
b
c
34 ...________....___•__•____?___._._,. . .
Check if: ? You were 65 or older ? Blind; FC] Spouse was 65 or older ? Blind.
Addthenumberofboxescheckedandenterthetotalhere . . . . . . . . ? 33a
If sameone (such as yaur parent) can claim you as a depentlent, check here .. 0- 33b ?
If you are married filing a separate return and your spouse itemizes deductions,
or you are s dual-status alien, see page 16 and check here. ....... ll? 33c ?
y nr ?
Enter the • Your standard deduction (from page 17 of the Instructions), OR
.
line 26).
larger
? Your itemized deductions (from Schedule A
{
1
/
4
35 .,
_..
,
of:
If you itemize, attach Schedule A and check here ..??
-
Subtrect lirie 34 from line 32
EnTer the result here
35
_
36 . . . . . . . . . . . . . . .
.
.
tions claimed on line 6e
M
lti
the total
ber of exem
l
$2
000 b 36
37 - ........
p
p
u
y
:
y
num
enter zero) .
Enter the result (if less than zero
Taxable income
Su6tract line 36 from line 35 37
38 ,
.
.
Caution: If under age 14 and you have more than $1,000 of investment income, check here 1, ?
and see page 17 to see if you have to use Form 8615 ta figure your tax.
Enter taz. Check'rf from: aKI Tax Table, b? Tax Rate Schedules, or c? Form 8615.
. .
(Ifan
Form(s)8814
enterthatamounthere?d I .)
isfrom
?
38 536
-
39 . .
,
y
.
..
Check if from: a? Form 4970 b? Form 4972
Addition
a
l ta
es (see
e 18) 39
40 ...
g
a
x
p
.
Addlines38and39.Enterthetotal . . . ? 40 36 --
41 Credit for fhild`and tlependent care expenses (attach Form 2441) 41
Credits 42 Credit far the e derly or the disa6led (aKach Schedu/e R) 42
(See 43 ...
Foreign tax credit (attach Form 1116) 43
Instructions
on page 18.)
44 . . . . . . . . .
General 6usineis credit. Check if from:
,
a? Form 3800 or b El Form (specify)
4
45 CreOitforprioryearminimumtax(attachForm8B01) 45
46 . . . .
Addlines4lthrou
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Enterthetotal . . . . . . . . 46
47 . . . . . . . . . . .
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48 Self-em
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53 ....
. . . . . . . . . . . . . . . . . .
Add lines 47 throu h 52. Enter the total ? 53
536
-
Medicare 54 . . . . . . . .
Suppiemental Medicare premium (attach Form 8808) 54
Premium 55 . . . . . .
Add lines 53 and 54. This is your total tax and any supplemental Medicare premium . .1- 55 --
56 check ? E))
Federal income tax withheld (if any is from Form(s) 1099 56
57 ,
1989 estimated tax payments and amount applied from 1988 return 57 64 -
Payments 58 Earned income credit (see page 20)
. 58
Attach Forms 59 . . . . . . . . .
Amount paid
with Form 4868 (extension request) 59
W-2, W.2G, 60 .....
.
Ezcess social securit
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and W-2P
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61 y
.
Credit for Federal tax on fuels (attach form 4136)
61
. 62 ....
Regulated.inJestmentcompanycredit(attachFOrm2439) . . 62
63 Add iines 56 through 62. These are your total payments . .?
64 If line 63 is larger than line 55, enter amount OVERPAID . . . . . . . . . . . . . ?
65 Amount of line 64 to be REFUNDED TO YOU . . . . . . . . . . . ?
Refundor 66 Amountofline64tobeAPPLIEDT0Y0UR1990ESTIMATEDTAX?1 66 1 %lZg }=
Amount 67 If line 55 is larger than line 63, enter AMOUNT YOU OWE. Attach check or money order for full
You Owe amount pzyable to "Internal Revenue Service." Write your social security number, daytime phone
number; and ".1989 Form 1040" on it . . . . . . . . . . . . . . . . . . . .
68 Penalty forunderpayment of estimated tax (see page 21) . 1 68 1 1 ??????? ?????.
SI n
S Under penalties of perjury, I tlttlare that I have examinetl this return antl accompanying scheEules and statements, and to the best of my knowletlge and
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ENVIRONMENTAL MANAGEMENT DEPARTMENT
GROUNDWATER PROTECTION SECTION
14955 Galaxie Avenue • Apple Valley, MN 55124
952.891.7557 • Fax 952.891.7588 • www.co.dakota.mn.us
MUNICIPAL NOTICE OF WELL SEALING PERMIT APPLICATION
DATE: July 2, 2004
TO: Tom Colbert/Wayne Schwanz (EM)
RE: Well Permit #: 04-H223205
Municipality: Eagan
Fax #: (651) 675-5694
Well Type: Domestic
Environmental Specialist: Olsen
The Water and Land Management Section of the Dakota County Environmental Management Department has
received the following permit application for the well described. If you requ've further review of the application or
if you have any questions or concerns about it, contact the Environmental Specialist listed above or our office at
(952) 891-701 l. If there is no response from yow 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:
Date Application Received:
Anticipated Drilling Date:
Anricipated Grouting Date:
Property Owner:
Well Owner:
WELL LOCATION:
Kimmes-Bauer Well Drilling
6/30/2004
Time:
Time:
Jason Smith
Jason Smith
PLS Coordinates: NE 1/4,,NE-1L4, NE 1L4, Sec 33 Town 27 Range 23
Street Address: _4605-Pilot-Knob-RD--- `
PIN Number: 107820002001
WELL INFORMATION:
Diameter: 4
Casing Depth: 221
Tatal Depth: 226
Static Water Level:
Aquifer:
COMMENTS:
File Edt Yiew Lctols $APGcatians Neip
?
ri? ,____.,._.
??? ? ? ?E&A??? . . _. ? _...,.
Gt?nnegtiorr ? Commenis I
Eagan Builsiing I Eagan flevelvpment ? Pernntte
Owner I EaW Assesst5ales I Eegaan Praper#y I Eogen
Pafcei ?D ? o?zaaozoa?
Address 4?15 PiL07 KNOB FIa .? ??.,?
A
?
c?
Search RID I SeardhHouse 4605
Owner 1
xi
I Owner 2
Clv,mer 3
I Owner 4
PuOr KNOs RD
- I#&
CUATES ALtELINE E ?.
4605 PILD7 Y,NCiB RLl .
EAGA.N MN 55122-2737
? --
?LMAJ
u f[T
- - - - - - - - - - - - - - - - -
I For Office Use
Permit
y .gig
City of Ea a~ 24
I Permit Fee: .J
3830 Pilot Knob Road Q~G Q 4 2000
Eagan MN 55122 Date Receive
Phone: (651) 675-5675
Fax: (651) 675-5694 ~r.Cy Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: / =q/ite Address: ~ /d
Tenant: Suite
6- 51-3 ~IYW`r-
RESIDENT/OWNER Name: , L t 7 s%'1il Phone:
Address / City / Zip: y 6z G -,V,4, Applicant is: Owner Contractor
TYPE OF WORK Description of work: A A0 4
k r} C N O 2i QG
Construction Cost:Multi Family Building: (Yes / No
CONTRACTOR Name: G li?.%' License
Address:
City: State: Zip:
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
submission type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
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.
Applicant's Printed Name Applicant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE C
SUB TYPES
? Foundation ? 05-plex ? 16-plex ? Accessory Building ? Pool
? Single Family ? 06-plex ? Fireplace ? Porch (3-season) ? Ext. Alt. - Multi
El 01 of _ Plex El 07-plex Garage El Porch (4-season) El Ext. Alt. - SF
? 02-Plex ? 08-plex ? Deck ? Porch (screen/gazebo/pergola) ? Multi Misc.
? 03-Plex ? 10-plex ? Lower Level ? Storm Damage
? 04-Plex ? 12-plex ? Miscellaneous
WORK TYPES
New ? Interior Improvement ? Siding ? Demolish Building*
Addition ? Move Building ? Reroof El Demolish Interior
? Alteration ? Fire Repair ? Windows ? Demolish Foundation
? Replacement ? Egress Window ? Water Damage
Demolition (entire building) - give PCA handout to applicant
DESCRIPTION:
Valuation 5 O(7~ Occupancy MCES System
Plan Review Code Edition SAC Units
(25% 100% Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Const. Width
REQUIRED INSPECTIONS
Footings (new bldg) Sheetrock Meter Size:
Footings (deck) Final/C.O.
Footings (addition) Final/No C.O.
HVAC
Foundation
Drain Tile Other:
Roof: -Ice & Water Final Pool: _Footings -Air/Gas Tests -Final
L Framing Siding: _Stucco Lath -Stone Lath -Brick
Fireplace:_R.I. Airiest -Final Windows
Insulation Retaining Wall
Reviewed By: Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review', q MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
Total
Page 2 of 3
L7 0 "Pi & a i'c
IIQ 11(2 16
MAW* OF F A
y 7 J
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA175460
Date Issued:04/05/2022
Permit Category:ePermit
Site Address: 4605 Pilot Knob Rd
Lot:2 Block: 1 Addition: Twin View Manor
PID:10-78200-01-020
Use:
Description:
Sub Type:Air Conditioner
Work Type:Replace
Description:
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Neil N Gronau
4605 Pilot Knob Rd
Eagan MN 55122
(651) 338-8804
Aquarius Home Services
3180 Country Dr
St. Paul MN 55117
(651) 777-0448
Applicant/Permitee: Signature Issued By: Signature