The URL can be used to link to this page

4865 Pilot Knob RdINSPECTION REC4RD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 ,--1 1 -, c+ , SITE ADDRESS: 1 1: 1 !. III? APPLICANT: ., , • ; i?ta A t ? .'1 6fi:'N ? ? ? ? PERAAIT SUBTYPE: TYPE OF WaRK: ? . ; .. ,? Permlt No. Permit Hoider Uate Telsphone # ELECTRIC PLUMBINCi HVAC Inspectlon Date Insp. Commenta 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 FTG DECK FINAL CITY OF EAGAN Addition Section 3)l Loc E Owner,- -:"-1-+? -- - ' '°.Z.s'ts%f, Street 4865 Pilot xnob Ra.. :!?VVo - c Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK , 1976 1 59 . 39.84 15 al SEWER I.ATERAL WATERMAIN WATER LATERAL WATER AREA 1982 2275.00 151.67 r " `???0 - CitG7Ll'GC STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALlC STREET LIGHT WATER CONN. BUILDING PER. SAC PARK EAGAN TOVO/N S H 1 P BUILDING PERMIT Ownea _34 11?-----`-.._......._......../ Addseas (Presenf) --. f -` /..-___..t.s----e--r.K._.??.._-..... Builder ------ ?fL ........--t;? -°--- ........................---...---- Address ---.....--......---------------"..---?----.-."---------------°'-'--'------... DESCRIPTION N° 945 Eagan Towaship Town Hall Dale ...... ?Ilf1...""--------------- 5tories To Be Used For Fron! Depth Heigh! Est. Cos4 Permt! Fee Remarks P ? ?U ?? / ?j .-.?r /5S •°= .? ? ? ?h J 9 e? . ? /J LOCATION SYree2, Road oz olher Descripiion of Location Lo! Block Additioa or Traei II •K asz IL.L?Y/ ef-f.-, `I This permif does noi au3horize the use of sfreefs, roads, alleps or sidewalks nor does it give the owner or his ageni the righi fo ereafe any sifualion which is a nuisance or whieh psesents a hazard 10 the heallh, safefy, eanvenience and general welfare !o anyone in the eommunity. THIS PERMIT MUST BE K?.. T O TH PREMISE WHILE THE WOAK IS IN PROGAESS. n?[ , This is fo cerfify. Shai ..............._.- . . ----...provis rN r: -------------- has permission !o erect a.... .....--- _-Ri..l.? .10"°?- upon the ebove dosaribed pr ise su!!o?j ioxis of the Building Ordinance for Ea?Township adopied pzi 11, 1955. .......................................... °--.._!/........._..._............-----..... Per .--------........i?..u-----/?.7....?.r...._........ Chairman of Tnwn Boerd Building Inspeetor c „- ( AC( __? CITY OF [FlGAN CAaNIEke S TrfiMINAL N0: 40 IIATE: 05/28/97 7IMF..: 15:51c55 SD: NAMEz FANEI_CRAFT OF MN INC 2155 9001 7.00 32'10 9001 4E365 F'ILUT FC1JC)B 93.75 :3210 9001 7E32 CAi'fPEfiWEI_L 21..00 32i.17 900i. 4673 CAHPR?X7GE 137.?5 'fn+,a7, Fecezp+, ,qrtroun+„ ?bSeUO CkOr43cii USFH 70: NANCV .? _ -.. CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-03400-058-29 PERMIT PERMIT TYPE: Permit Number: Date Issued: 4865 PILOT LOT: 5 BLOCK: SECTION 34 SUILDING 030037 05J27/97 DESCRIPTION: REMARKS: KNOB R? 29 SF (IqISC.) REPAIR 434 ALT. RESIDENTIAI_ r? tr-- C.,. FEE SUMMARY: Base Fee Surcharge Total Fee VALUATION $99.75 $2.50 $102.25 $5,000 CONTRACTOR: - A p p 1 i c a n t- s T. L?OWNER: PANELCRAFT OF MN TNC 17216628 00021 9 LEHMANN FRANK 3118 SNELLING RV[ S 4865 PTLOT KNOB RD MIIVNEAPOLI5 MN 55406 EAGAN MN (612) 721-6625 (612)454-1867 I her2by acknow3.edge that T 11ave reail Chis ap{slieation arid state that the infiormation fs? correct and agxee ta camply with aIl appllca41e State of Mn. 3tatwtes and Clty'of Eagan OrdinanceS,, L APPLICANTlPERMITEE SIGNATURE ISSU BY: SIGNATURE AA ROOF ".'Buil"djn9 Permit Type Btti2diYTglWork Type Census Co ife... x ? 6 f : ? j, ? CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 ? 3 registered site surveys ? 2 copies of plans (inGude beam & window sizes; poured fnd. design; elc.) ? 1 anergy calculalions ? 3 copies of tree preservatian plan if lot platted aRer 711193 required: _ Yes _ No Remodel/Reoair ReQyjLements ? 2 copies of plan ? 2 sile swveys (exterior addkions 8 decks) ? t energy calculations for heated additions DATE: /? / CONSTRUCTION COST: DESCRIPTION OF WORK: STREET ADDRESS: / -? LOT 5 BLOCK 2- SUBD./P.I.D. #: 41;zap/ ?'Ieo -4d`D82?J PROPERTY Name: Phone #: OWNER ,? `?" Street Address: ' /?? az oQw City: G"QI7 _ State: Zip: CoN7itAC7ott Company: Phone #: Street Address: License #: City: /v;?G?? 5tate: I-IA Zip: ARCHITECT! Company: Phone #: ENGINEER Name: Registration Street Address: City. State: Zip: Sewer & water licensed plumber: Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the infounation is correct rtd agr ?to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. / Signature of Applicant: .?? C OFFICE USE ONLY \ J Certificates of Survey Received Tree Preservation Plan Received _ Yes _ No _ Yes _ No P C 7-199? i ti?AY 2 OFFICE USE ONLY BUILDING PERMIT TYPE X 1 Foundation ? 06 Duplex 02 2 SF Dwelling ? 07 4-piex ? 03 SF Addition o 08 8-plex ? 04 SF Porch o 09 12-piex ? 05 SF Misc. ? 10 _-plex WORK TYPE ? 31 New ? J33 Alterations ? 32 Addition V 34 Repair GENERAL INFORMATION ConsL (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning ? 11 Apt./Lodging ? ? 72 Multi RepairlRem. ? ? 13 Garage/Accessory ? ? 14 Fireplace ? ? 15 Deck 0 36 Move ? 37 Demolition Basement sq. k. Main level sq. ft. sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building Engineering Variance Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit SNV Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: G?- ??s Valuation: $ 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous MC/WS System City Water Fire Sprinkiered PRV Booster Pump Census Code. SAC Code Census Bldg Census Unit Q!?, % SAC SAC Units r .?. .. city oF eegan THOMASEGAN Mayor September 9, 1993 ANNETTE M MARGARITE SEVERSON WILCOX & SHELDON PA 600 MIDWAY NATIONAL BANK BLDG 7300 W 147TH ST APPLE VALLEY MN 55124 Re: Assessment Appeals for Pilot Knob Road Project 590 Daniel Henschen (Parcel-10-03400-011-50) Frank Lehman (Parcel 10-03400-50-29) ? Dear Annette: PATRICIA AWADA SHAWN HUNTER SANDRA A. MASIN THEODORE WACNTER Council Members THOMAS HEDGES City Adminisirafor E. J. VAN OVERBEKE CIN qerk Enclosed please find the above-referenced Stipulation Agreements & related Resolutions. After full execution, please return one copy to the Ciry for our record keeping purposes. Thanks, Annette. Sincerely, , J dy . ms ineering Secretary /jmj Enclosure: 6 Original Stipulation Agreements (3 Per Parcel) 1 Original Resolution (1 Per Parcel) MUNICIPAL CENTER 3030 PILOi KNOB ROAD EAGAN. MINNESOTA 55122-1897 PHONE: (612) 681•4600 FAX:(612) 681-4612 iDD: (612) 454-5535 THE LONE OAK TREE THE SVMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY Equal OpportunitylAffirmative Actlon Employer MAINiENANCE FACILITY 3501 COACHMAN POINi EAGAN. MINNESOiA 55122 PHONE: (612) 681-4300 FAX:(612) 681-4360 TDD: (612) 454-8535 . , 6 STATE OF MINNESOTA COUNTY OF DAKOTA Frank and Laverna Lehmann, husband and wife, Appellants, v. City of Eagan, Dakota County, Minnesota, a municipal corporation, Respondent. DISTRICT COURT - FIRST JUDICIAL DISTRICT Court File No. C7-92-9762 STIPIILATION,. ORDER FOR JDDCMENT AND JIID(iMENT WHEREAS, Appellants Frank Lehmann and LaVerna Lehmann are the fee owners of the parcel of land with an identification number of 10-03400r_.050-29 ("SUUject Property"); and WHEREAS, on November 5, 1992, Respondent City of Eagan ("City") assessed the Subject Property the sum of $8,340.00 for street construction as part of Project No. 590; and WI-IEREAS, Appellants brought an action in District Court appealing the sum of the assessments for Project No. 590 known as Frank and T•aVerna Lehmann v. City of Eagan, Dakota County District Court File No. C7-92-9762; and WHEREAS, the parties have resolved any dispute over assessments to the Subject Property. NOW, THEREFORE, the parties do hereby agree as follows: 1. The assessment levied against the Subject Property for Project No. 590 shall be reassessed in the sum of $1,000.00. 2. Appellants shall waive notice of hearing and hearing on the reassessment. 3. The City shall direct the Dakota County Treasurer to recompute Appellants' real estate tax statement using the new assessment figure of $1,000.00. 4. Following the execution of this Stipulation, Court File No. C7-92-9762 shall be dismissed with prejudice and without costs to either parties. Dated: ` - [ Dated: Cl ' f , 1993. By: E. J. VanOverbeke Its: 'ty Clerk a ? Dated: 1993. Frank Lehmann Dated: 1993. cf? / ,-, 7-<.;?_•( LaVerna Lehmann STATE OF MINNESOTA ) ss. COFJNTY OF DAKOTA ) On this 7,k4, day of 3",L,4t`' , 1993, before me a Notary Public within and for said Coun y, personally appeared THOMAS A. EGAN and E. J. VanOVERBEKE to me personally known, who being each by me duly sworn, each did say that they are respectively the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing instrument, and that the seal affixed on behalf of said municipality by authority of its City Council and said Mayor and Clerk acknowledged said instrument to be the free act and deed of said municipality. jo? V JUDY M. JENY.INS ? NOTARY pUBUC - MINNEgOTA ' DAKOTA COUNTY MY 00"WM4bn exWroe 7-2247 STATE OF MINNESOTA ? ss. COUNTY OF ) On this ? day of ?, 1993, before me a Notary Public within and for said C unty, personally appeared FRANK LEHMANN and LaVERNA LEHMANN, to me personally known to be the persons described in and who executed the foregoing instrument and acknowledged that they executed the same as their free act and deed. i ANNETfE M. MARGARIT yJ NOTARY PUBLIC^MINNESOiA ? NENNEPIN COUNIY My ?BtYni? f?{NflN ?EN ? 1881 ..I ..,., w.. n.! ? Y. a,.... C. s?:: Y fj, Notary Public APPROVED AS TO FORM: City Attorn y' Of-ice Dated: ? APPROVED AS TO CONTENT: k. ' JM- Le" ji nce Department a: q- h-?13 THIS INSTRUMENT WAS DRAFTED BY: SEVERSON, WILCOX & SHELDON, P.A. 600 Midway National Bank Building 7300 West 147th Street Apple Valley, Minnesota 55124 (612) 432-3136 AMM/wkt ORDER FOR JDDGMENT Based upon the foregoing Stipulation entered into by and between the City of Eagan and Frank Lehmann and LaVerna Lehmann; IT IS FORTHWITH. Dated: THE ORDER OF THE COURT THAT JUDGMENT BE ENTERED BY THE COURT: , 1993 JUDGE OF DISTRICT COURT I certify that the above constitutes a judgment of the court. NDGMENT ENTERED AND FILED THIS DAY OF (SEAL) BY THE COURT ROGER W. SAMES DISTRICT COURT ADMINISTRATOR Deputy , 1993. RESOLQTION OF THE CITY OF EAGAN ADOPTINf3 BTIPULATION OF SETTLEMENT WHEREAS, on November 5, 1992, the City of Eagan assessed land identified by Property Identification Number 10-03400-050-29 ("Subject Property") for street improvements as part of Public Zmprovement Project No. 590; and WHEREAS, Frank Lehmann and LaVerna Lehmann, the owners of the Subject Property, have brought an action in District Court appealing the assessment identified as Dakota County District Court File No. C7-92-9762; and WfiEREAS, the parties to this case have settled the assessment dispute according to the terms described in the attached Stipulation. NOW, THEREFORE, be it resolved, the Eagan City Council hereby adopts the attached Stipulation resolving this assessment appeal and authorizes the Mayor and City Clerk to execute the Stipulation on the City's behalf. Dated: - , 19 ---- -°? -- ATTEST: Cd 1100?,? Lxtc-" By: E' . VanOverbeke Its: 'ty Clerk RECEIVED SE? 2 1993 MEMORANDUM PRIVILEGED AND CONFIDENTIAL TO: Thomas A. Egan, Mayor Pat Awada, Councilmember Shawn Hunter, Councilmember Sandra Masin, Councilmember Ted Wachter, Councilmember Tom Hedges, City Administrator FROM: Annette M. Margarit, Assistant City Attorney DATE: September 2, 1993 RE: Daniel Henschen v. City of Eagan; Frank Lehmann v. City of Eagan; Assessment Appeals for Pilot Knob Road; Project 590 Daniel and Patty Henschen are the owners of a tax parcel identified as 10-03400-011-50 which was assessed $3,303.60 for street improvements as part of Public Improvement Project No. 590 concerning the upgrade of Pilot Knob R_ oad_ Frank-and Laverna Lehmann are the owners of parcel number?10-03400-50-29 w1l-ich was assessed $8,340.80 for the Pilot Knob Road upgrade-5ee-the attached map for location of the parcels. The parcels were assessed on a front foot basis. Both the Henschens and Lehmanns have filed appeals of the levied assessments. These matters are set for trial on September 8 and 15, 1993. Pursuant to our request, Tom Metzen, real estate appraiser, inspected the properties to give us an initial opinion of the benefit derived by these parcels from the Project. A copy of Mr. Metzen's letter is attached. As indicated in his letter, Mr. Metzen believes the maximum benefit of the Project is $1,000.00 and may be as small as $0. I contacted Larry Danich of Mr. Met2en's office to learn the basis of their opinion. His position is that the City is faced with the issue of trying to determine how a reconstructed minor arterial road benefits a residential property. Utilities were not part of the Project so the sole benefit would be for the improved street in front of the parcels. Prior to the Project, the parcels had a paved road with a gravel shoulder and drainage ditch. The Project provided a wider paved road with curb and gutter. Larry Danich is of the opinion that a buyer of residential property expects a paved road, but will not pay for a wider paved road which may be what he termed, "an overimprovement." I met with each of the property owners on their parcels and observed that the Henschens' driveway now has a significantly increased slope up to the street which they did not have before the Project. Both parties' driveways now have to cross the bike trail which was built on their side of the road as part of the Project. The road is much closer to both the Henschen house and the Lehmann house as a result of the Project. Both parcels experienced a tremendous loss in trees due to the road expansion. Both parties are convinced that the traffic and the attendant noise on Pilot Knob have increased and complained that the traffic moves faster than before the Project. Ms. Lehmann particularly contended that her house is so close to the peak of the hill that if one is traveling south, it is now dangerous in attempting to come to a complete stop in order to turn into her driveway. Her driveway is approximately one-tenth of a mile coming down the hill as one travels south on Pilot Knob Road. I have had discussions with both the Henschens and the Lehmanns in an attempt to resolve this case. The Henschens and Lehmanns have agreed to dismiss their appeal if the City reduces the assessments to $1,000.00 payable under the same terms as the original assessment with interest accruing after the proposed reassessment. It is my understanding that the Lehmanns intend to pay their assessment in a lump sum within 30 days of the reassessment. The $1,000.00 sum reflects the maximum benefit Mr. Metzen found in his appraisal and saves the City the expense of having to go to trial. This settlement is based on the combination of effects the Project had on these unique parcels and does not have any precedential value for future improvement projects. I recommend the City Council adopt the attached Stipulations for Settlement. AMM/wkt cc: Tom Colbert, Director of Public Works Gene VanOverbeke, City Clerk Jim Sheldon, City Attorney . ? - -r- lA ?-?-- REgEC?? ' i 4 3 2 ? \ ?7 , \ J ?,?_.. OO :o 9 (? 'd50-29: ? I Lehmann ? ,a 11 i N : tn .. ? ... ? ... ? N I^d f 'r- Henschen Section L GRACF N Assessabie Footage I OUTL POT B ? 1 ti a y a ? I ?? o o I OUTLOT C o I ? ? I ... ?... ?... ?... ?... ... ... ?..' ?"' ? .?. I 021-51 + a Oto-51 ? o M i I f I , Is IN ? ?o o zoo aoo !Tsiiig Scale in feet LP-56 Dakota Co. Rd. No. 31 (Pilot Knob Road) Assessable Footage City Project No. 590 o pS?St " gP' O?y G? ?Pr'?R?? ' O ? L0 (D --010-52 (Owned by Dakota County) ? 8oneatroo Fioaene E:m Anderlik 6 n Aasoclntee oote: Aprii 1990 Comm. 49505 EnplneQn 8t. Paul 1111nnawM Fg. No. 3 July 12, 1993 Severson, Wilcox & Sheldon, P.A. 600 Midway National Bank Bldg. 7300 West 147th Street Apple Valley, Minnesota 55124 RE: Project Number 590 Parcel Numbers: 10-03400-050-29 10-03300-012-75 ? 10-03400-011-50 Annette M. Margarit, As per your request, I have made an inspection of ?', •- "- ' ? the Lehmann and Henschen parcels and reviewed the project report outlining the scope and cost of the improvements. As with any assessment appeal, it is very difficult to produce comparable sales that indicate an immediate increase in value equal to the cost of a utility and street improvement. After careful and substantial examination of the parcels and considering the effect of the project, I am of the opinion that the benefit of the project to the above-described parcels would be anywhere from $0 to $1,000 per parcel. In the event you require the completed, full appraisal report, i will certainly provide that for you, however, considering my anticipated conclusions, it appears prudent to negotiated based on these preliminary findings. Please contact me iP you require additional information or documents. ,..., . ._ Respectfull submitte3, . ' homas F l n, CREA #18386 Minnesota I.D. #4000158 TFM:lb ? ?.?y! 1 !'? 1.1 I .?......?.. ? ` i?p P1?.? 3.r.?._'_.T ? _....J'. HVIE'J 6L'dD.150UTH SAINT PAUL! MINNESOTA 55075i PHONE: 455-2214 • FHXt :5?_'72E o? SCREENS 26,29&30 REAL ESTATE INQUIRY - NAME/ADDRESS/LEGRL XINPNO03 PARCEL ID: ln 03400 050 29 PLAT NAMEs SECTION 34 TWN 27 RRNGE 23 HOMESTEAD CARD ENTEREDa 02 07 1991 FIRST DIVISION: LRST DIVISION: FEE CURRENT OWNER: FRRNK & LRVERNR LEHMRNN 4865 PILOT KNOP RD 5RINT RRUL MN 55122-2740 TRANSFER TO SCREEN NUMBER: PF8-SCROLL FORWHRD LEGAL: S 417 FT OF E 359 FT OF E 1/2 OF NE 1/4 OF 5EC 33-27-23 pL50 PT OF SW 1/4 OF NW 1/4 SEC 34-27-23 BEG 5W COR N 417 FT E TO SRR #19 SE ON RD TO S LINE W 132 FT TO BEG 34 2723 e,smnfi PRRec? ? on C.1"y maf ib o :?_ !R -q / 'IC): ANN (30ER5, SPF]CIAL ASSESSf= CIERK FRU!I: 7HOMAS A. COLBERT, DIRD=R (7E' PUBLSC TJ177RKS DATE: OCPOBER 22, 1981 RE: PRQ7ECP 264, CANCFLIATI(N OF SPECIAL ASSESSPqWS'S -iPP.RCEL 10 03300 050 29 f At the Cotmcil Meeting of october 20, 1981, the Council foxmally deleted the tnvilc area water assessment for the above-referenced Parcel under Pm- ject 264, which had been levied in the anrotmt of $2,275.00. This assess- ment is tA be deleted until future projects provide watermain availability directly to this property. Please remve this parcel frae the assessment roll that is to be certified to the Coimtv. TAC/jach City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4865 Pilot Knob Rd Lot: 5 Block: 29 Addition: Section 34 PID:10- 03400 - 050 -29 Use: Description: Sub Type: e - Air Conditioner Work Type: New Description: Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mar k Anderson, State Electrical Inspector, 952- 445 -2840. Cindy Lilienthal 21210 Eaton Ave Farmington, mn 55024 651- 344 -4253 clilienthal @controlleda ir.net Fee Summary: Contractor: Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460 -6022 X253 Surcharge -Fixed ME - Permit Fee (Replacements) Total: Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - $0.50 $30.00 $30.50 Owner: Frank Lehmann 4865 Pilot Knob Rd Eagan MN 55122 Permit Type: Permit Number: Date Issued: Permit Category: 9001 0801 Mechanical EA075745 11/01/2006 ePermit I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Issued By: Signature City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4865 Pilot Knob Rd Lot: 5 Block: 29 Addition: Section 34 PID:10- 03400 - 050 -29 Use: Description: Sub Type: e- Reroof Work Type: Replace Description: House & Garage Census Code: 434 - Zoning: Square Feet: 0 Comments: If there is no ice protection inspec acceptable in lieu of inspections. Fee Summary: Valuation: 3,000.00 Contractor: Apex Roofing & Siding 944 Oriole Dr Apple Valley MN 55124 -0000 (952) 891 -1919 BL - Base Fee $3K Surcharge - Based on Valuation $3K Total: Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - Construction Type: Occupancy: on prior to final, you must meet inspector with ladder and flat bar. Pictures are not Owner: Frank Lehmann 4865 Pilot Knob Rd Eagan MN 55122 Permit Type: Permit Number: Date Issued: Permit Category: $88.50 0801.4085 $1.50 9001.2195 $90.00 Issued By: Signature Building EA087175 10/29/2008 ePermit I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Use BLUE or BLACK7nk � ForOfficeUse---------� � j Permit#:��a� I Clty of ��n ; P �s ; � ermit fee. � � 3830 Pilot Knob Road Eagan MN 55122 � "''` _ � Date Received: � Phone:(651)675-5675 ` � � Fax: (651)675-5694 i Staff: � � � �. . . . � ��_��_J � 2014 RESfDENTIAL BUILDING PERMIT APPLICATION Date: SiteAddress: �� ri•�C�l �� G� Unit#: � � � �� Name: � �l. �� 1 �� rn� � � � Phone: �� e�-�� J Q �� Resident/� � � � � � � � � � � OWI121', �� Address/City/Zip: ��Cp S �� 1�� a( � Applicant is: Owner Contractor � �� -� � � � � Type of W�Or'k � Description ofwork: �� "� �� —�-1 O ��0� � 1�� i°Yl�� ` ��a, ; Construction Cost:� �� . � � � M'ulti-Family Buiiding: (Yes � 7 No J� ) iI� 11►� --f-a►� ��` �'�'"—�-� �j—�—�u� � Company: �, � 1-tt�I�(l�( �f�'�p�01/Q, Contact: T_ Contracfor : address?J��J� ,��'Clc��UJ(��O I�-- �� c�ty: Cj-�-, �C�i/ i S pq� IC State�"`� Zip: �� Phone: I� `� ✓�Y��aiL ,/�l �✓�l�f�(XQp I( 5�(�el jf�+�( ,(Ji�!j , /� �1 f-��✓� �►-rr p ro�Yr1�2 r�-��r C�o License#: lp�� '-t � Lead Certificate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING 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: IVOTE Plans and supporting documents that you submif are`cons�dered to be public►nformat�on �fPortions of ! � the;�nformat�on�may be�classified as�non-pubhc�if you prov�de;spec►fic reasons that would perm�it the City to� '� �� , ;" : ,: z � z = r � � rf � ��_�� " � ��' � ' w:conclude that;the �are trade secr`ets., ,�r�°'� �,:. ' ` ' �_ � � � � � 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.qopherstateonecall.orq 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 approvai of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. _�^ x � 1 v 1� f� X ApplicanYs Printed Na e ApplicanYs Signature age 1 of 3 .....,, ,.,.�y... , _ .��_. m.� ,�.,�. .�..,R.....� �.,, . . . .� ��w��,�.�..�m.,�. w..,.��„�., �� M �.._�� . �„��rv .�,,,�,.�.,�,��,�.�,. r��,m.�_ ��.a . � ` � Use BLUE or BLACK Ink � ,----------------,�a�� For Office Use �/.�� I PeRnit#: �?"`� 1 I_ C�t of �� aIl ; . �� Permd Fee: � �� 3830 Pilot Knob Road � �� Eagan MN 55122 � � Phone:(651)675-5675 � Date Received: d��" � Fax:(651j675-5694 � � , : _ ��v t� � Staff: � ��J 2015 BUILDING MOVE PERMIT APPLICATION Date: �`�Z�'�s Address of Building to be Moved: ''�fs�,.S" /��l�'� �1�zr�C'� �� Proposed Destination: City: �-a.�.�u.� t �.x"�i,�r State: f��A/, "Highlight origin, route, &destination on current City map. If County/State roads are used, provide copies of those permits Proposed Date to Move: Date: z a �°s's � c-/c�-,�.� Time: d�.3�/` �d ,S:ir► (RM �C /PM� 'Please notify the Eagan Police Department of you move. The Eagan Police Department will not accompany move until time coordination has been made with neighboring municipality. � Size of Structure: /�e+ .s.� ��,�'� a . L,.a�,�ay Weight: -�' �cr�� -- 7��r Structure is connected to: (please check all that apply) City Water City Sewer Septic �Well )C Electric Seroice Gas Service Other: Party responsible for disconnect: �C Owner Mover Other: �_ Building in Eagan to be moved out of Eagan. Building in Eagan to be relocated in Eagan (requires Council action). ' Building to be moved into Eagan from another C�y(requires Council action). I, } , Name:�'c�y�iCr�✓��^t.�rc�c�- :�zr°ct� Phone: G�`%' ��3V.3�� I �u1td��+��' ` Address/City/Zip:0 �/' ;�:3E''�- t ��cas rn �'r.a� �iit� .��`�� F.' Name: �,�� ls�� Phone: ��°�� :� Address/City/Zip: }� : If land owner is NOT the same as building owner,provide approva/from/and owner to work on the ro e ��1��d" �� . �`� � � ° � � � P ' �$ � � � � . f .' '� � �'a #�� S � �'� � �'' �3 tY' ", r p�ry�k�gy� �.�[� �r �r �,}. {�,y �y " f�wT+*I a�Qk� w��'�.��JS%�'�Tr�F�,��k€��/iy� �; � y, r` # !�, { � .�'� .?z- 4 � t � ,;; 'S f s � � ��, �� .� f 1 i �. ; ,� � uy �� m �A2�YC ta!YaiKy��+Y'�M\�'� � g'�� " ;dX iFi+.w..M,�+W�t� S+� M �, F�T�EUTi�'VFF S M;y 52 < § . � ,+' p f �f � i"£. 1 i M.: . . 1 � p } " '�_ }� �i� y � t' :� f:"r 1 �;� � 4Y N` � �� 4.��G��'�i"C�� } 7 f v t � 4 � 2 �� i G , ,- ' e _ 'R 3 � *' !f. �k '� 4 3 � s <n � +v' � u �� . ^� �. ` ;t �, 5 f 5- J EY T � � ,. �' ; :�# .� � J , �. � . ; .. t' t t, . } =F �� a .,} _ x . $ x � � . t �� . , ,- r �, ,�. �� ..;e �'' +'u��:t .�� `_`� `, �3` f ,y„ , ,.: . ,>., �. ..,,�_ ....-�. . .,.. , . , � � . � � . ......_F: '..�A ,. _ . . ,. . . ,...... . ....... .,�:", . ..,.,�..,.W.wr.,y„, � �. CALL ��FORE YOU DIG. Call Gopher State One Call at(651)454�02 for protection against underground utitity damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq �� 'f��T o 1� �Q�P M IG a Dak Co � �±\`�9 OR. BRIAft CREEK RO. STONY p HY� WOpO �`� �"O p $ o c� DEERCIIFF '�"' C O ON 9 C y fQP �. �e ry� Center �L.ibrary � cr. G�acier 0,9Fq j r Ro �ro cT<•'` � Mi 'lnckhawkPark ��' M'�'C if� 86 4'��J.. Hi��s O N'_BURY J KE11lE DANBURY OR- ? �l `r F,� i DEERCLIFF �N� a Elem.Rurhara Curn�m PqtH CT Pp�� y B�p W 0 p . CIVIC �'CdSCdd2 3 /�(]Yk llll1[�L'1'.J3/ � SAVANNAH �p.. CRF.� + � � Tp. �P°j O � Sy�O�� O � CIVFC BaY WINDCREST . q� �r y1P� P � J2� < IK\NG `N_ 0 AfBf12OO AVE. K, I\ wBU � � Q OANBURV �O � �Oi 'rp -�\ . P� , CRESNEW F � / �qWK� �/ N�5 I �ROCKV LN. � �PP j��_ �� kNOC(Te�RY j �R�I � �I ySOQ..o5R�2�1� oS�G. z\ W��S �I Blll(I ''�AL �<t pti 3 CaE51 CUTTERS LN. - � r z �� FRS _ o``�:. � � oR "�0°� m• r�` � � �o�� \ � Lake .NA �� ROCKV C 9 � - L _ OV'C \ m 4. _RapuR .a q<a �. / J i�crc>� . I� � � . _ a�. �y�2 0 �. � :3` i ' t _ o =�' � ' , r e'm�l- �� --.. .o r.coNO�zoe,� r� oP�. r � -.�.in R "'�'.� .rvCOO�S�P Q -', p�O ��.. APPPLOOS R �y\\G E�'� Oq . i.EaTB�RV � ..: GS '� z��p0 G� '�O� .� C .� �- --- - IOR IEM PARK I RD. / �A�` ' s >'e ° -- �oE i =_ a�n.- 83i F�voco �,a'� o o pa� : � � Ar'HOUSZ —�_ � a} �' . ' � ,111R 4� pt 9 .ry.� O y� '_2'�N, H C�y � .. ' _ . .,.��' ''. ...,, ° ' DE'c��.VC00 OftYE � < . �i;•� ... � .._ —_'"—._-_ ___ � t .�..�. R Gp F '._. _ . .' : ... . a � y��,4 t ,- :g a_. �a K OE ft Tv � o `t��\\ .-Y OR �M1 "'+e.' � `A � �, { �� = L^OV� D _r•N�0 � i �.� - . i ➢��Y , a '� -IL �^y ' Y�` _ t . , _ '� '� �ON �i ,,.. cr � Biackha k� r. o e��r ,NT� t �� '� -� ° F�° � � o °>+ 61ir �e �' � .,. :°rrqr �� l� ! � w .'� `� ��'� �`� . zEa�` - 60, 63� :��0 oeeam000 - �''oti �Yloone�r �k ec � P,inic.4 3 r�can,vieev oi �, ,— u �-. � •,�� .._ PA�H cr � Lake ', Eu�un CF, e�gan �, � �ea� rq��ti �p� c,�sHE� o ��Ppi. 0�6 l� �� Pm'k f�, �6. High � : °� °"� � �" �� e°�' `'�� . eeaRV R�� / °� G�j, DakoW Schoot I 2� � �i �� o..._� � �� `jO� �,i -. � a�� BgO.�--� eexno�� 1 �2 Hilis �64, � �p avE � � =� I o ca � o o�z �/Rqsp � Middle� � �� . .r O �H 0�� o m NQE /i � o lN BFRRY �r CEIA � \F' \�(_� ,f. �� \ �\g qMBER.EAf �� 91 ` OPK ¢� O � Y?� Q p'[B C(I 0111 CT 1pm ��y �� AKBRK 1 SUMACPL ��p�F r e� t P��S� 2�0� Ni PG J 1cR �� TR i�llPQI'k I ....,"^"".. G r Northview \q� �'� OP 2.YFN PT_ H ,�4. y `. � NIP ' �� °'/ � DIFFLE ROAD Q1 �68 Etem. �� DIFFL O /.BOULDER RIOGE , 3O p Wti� 5.FIR PT 12. ]. � � y EASTER ° �N. 2 �--y U 0. wU Q111e � tEXINGTON � � CURRY p U �� z > 'S. a x H i � �N. ? 8 N Q, 1 �4ry1 � a pUnQ y p ST.A �N. p p O RIDGE CT. ��G � TRILLIVM GT F< rR �Q � 3 a yetnP p SIGFRI ST ST. E. GF� 0 � �. C4 011t LwYlh �a�n Di � x �/ YOR C � U w ,�.i s a F� P� � P o n d P o r k � 5 ? Z 2 �.�, P S I �� pATRI K R�F � < o � �vo ��+`'° od aeMSOn nera K � ?� 2 � �g ,� Ar t Par k A l h l e tie Faci lity aoAO c o r�e F i o w R c r � w o Q � M { GIR. U E.BAlSAM Z 2 B �^ ��5. � I� ? �� UJ p' � > Pl aU il K 4S. W CT u� N E. AISqM p y I WILDFLOW R CT. m 5 J � 3 Y w BKSAM ST ST F r X' E �SUMMIT� = C(II'1SOi1 R n �t' 0. 2 g p P G LEXINGTON u BMDOOGK (a�'�t. �' '�'Z' F p B4Y�pR OQ� a ¢ CIEOME �n. S Lake O I �N`�/'�� a<� � WALNUT ftIDGE 3 �/ Y E OAK Rl U CT J� � > C J �1. �R 'YT `i°� P '(a � r f p�e S w cosMOS m Par•k°^l.ro � e BnisnM �`�y ° z � �` r-._ e Pawa+ t�1 �C�eMS � � � GS. PON EROSA N WALF ~N. i O QkP h � =f _ O F 3 N Y � I O _ u w u � Q y m f . 3k :.0� DR. U jLakes 16 CIR. gT MARYll15 y 2 8 ,.Y•��2,/I4 p p Q� 19 K � JEFFERSON o GOpN �9e�Downrng E'�C1'PI�I•Qen LN.FIf2 i i i O CARLSON o oa�Q Q �3 U (�jOG��l�j f Q LANE OP' i .m, Park 0 Park w G Sta. o N� �rc E rc =� �q " Pu�k � NnMi�roN a a IL90 NE55 � �U f URUN R�� 3 ' A�UARIUS � LN. � � LIVINGSt� TlClfi Q Xighl�e Trai/ �� 4 Oak 7 . � Fan ry N P,3 4Q Eas?om �Iq. �R. �(p �� Chase Fe�1 � � fYalnutHillPark =� y��`'� P � o �MAl1.qRD �� n Thomas'�'e OP� � c~i O9R4' PtiI,� N�l �� - TIfF NY K'ILDER o QPP .. (q,�rP �°V o . ss �RuH R t�EP �2' I oR WF�W NESS R�,y 30. �P. � TTIOIItOS LQ WILDERNE55 � a 5- � � oo s o Ro Oak Pand o TMoru�s Lake u " o c� 2 . a'� Q No � lN.o s b r M� a Park 2� LN. CHASE �(i Y ' CF_I RiH op y y p? Thomas LBka East h-, 9 ,� Q '�`9.�\ e o Hi!!s Park� V1RD OR. �D �O ERNE55 'f 2� �1 � I EDGWO00 LN ; �o SUDBERRV (undev.)� �pKE5�0E O � � Wq�RFORD �NE � �i\GK�aV MPLLARD � F p w THOMAS p GURVE o m Ravine Park(und .) Q' SOUTH o GI0.. � a OAKLEAF �E�N V� �H CREST � DR.E. q� H`� � g UKE Q��Thomas Lake �m 5 MAR CIR. n QPµ(+�C � 0�R GIR. �+ qp� Py0 o HE �-�y HICKORY P s ��j A m O lN. - BERRY P C�'B 3 p yrc EM�� ' 4� ' LN. CENTER � ¢ 13 A� f U OUN LN. o�. �Y LLI Y U> ¢O �("�_„ I �u � `'E O o0 C/FF KF �.,..�y O �N� N N m 9 g a S.Wdi £ w �NP ¢ ?O � � ( �A P�' T LN. O O p� Trtmnt �Clearwater� OP�� GR' h� w_ z U Y RQq �O N��S 0.�. iu* cr (CO.R0.32) p CLIFF ROADP�ant `-' Park �1 cR RIIpN �I° � � / LANCASTER F Slp Wnlde�� ANDftEW Parkview I �..�"� �� WFY � BEACON NF AhF. RICHqRD'S \ HIIL W. (+ � C'!�l/f 59 riO�f qR� i � �. . °p r � % cr , . Course �<iF�, ou8 F'� o �o j�, m 50 � yF e4� J� �? � Holland McD°n e r e � Q f � � a k � �ak � � � m R `3� Lake 0J p� � rN qHp < � p. 2G" O �M.9S ~ D RES I/ry RFW ¢ °U � . ?� � � �F u �n. �N. rFR� e�� Q i . �� _ � w C PARKRIDGE DR ` 0� U � � �F I � t�� p Z O O O � N Dfl. "" � GVINGTN. � 3 J p �J `r I.\ y� 1 �._JC� r��l VU�I•�� I � croN �N o ��R. Lebanon Hills �> N E m \NG S N_ y �P P,NEtRfE T R n I L �� E B E C ,�m3r �ll�t �1:�� RegionalPark � . c,a. cct. �,,ry�e- �N. �moY George ,:. . . . . � Sehulze eencoN � PINETREE pASS � '� Q Ohmann '. Lake n l HILL p�s aR. �� > �a te Park ? � FQ.�,e � `� �SHEfYW000 "3 ^ � �� Canail � . � Lake P�� OR. 'Yp� WAV WqY GRACE DR. } i � J NQµW0�0 c'D WEIIINGTON � ; • . o SHEF. G , s?o � �. C�MP � p ��F. N wF[��h, s"��y �ti°tiss 4 .. I fP�. Burtvin �. SMER. V CTGTp'V ' � ,--O-R-�.�-Iy ' � P 1 POITQgC �'. SHERWOOD WAY CT � ��N�� P� Q. p �H� ! I LQICC .. R NChqM UrU � ¢ CnRauGE � '� V I ` O I r0�a Lebanon Hr!!s � Y . Jensen Lake Va�o.1,a Regiawl Park , . � � .. V 0 � � _._ ._----- .------_ _. . _Q ______L .- - - __ _ ._ __ ___ ___ __..__ -- ------__...� i ! ; ROSEMO� 1550 �"''T440'�� 1250 1100 950 E � F � G i H L I i J �F�:� ��- °�� :� � � � � � � � � , � V U c �„ (� � � ° � =� � �^ � � > � � �,. a �� ¢ i a � A 'o ��,� > � : � o-a �` �' ea c�i:m E-�: e �,a w, _ � � � ; u €z+ - - vi W . c � a - �:y �" � � i o /�� !�/. ^ u' � .�'i � � � Li�� L W � � A� � � � y ., a �o � � m o:c c^ � � � o � � �° o ,� +� �4? � ir � � ;� � �: � :'.. vwj �.� *�-a �.�N � � � . . � �� .. � � 4�.. � � .<� � ,� .¢ � . - . .� ��. � .�.. Z ��: � .� s .�.a � .y .�� . � � N � �� 'u ..� _,f,� � . y � �� .. . �� .� � '� �-.. � -: � � N 3 � ..� � . a . �°° L :�� : � � y � �+''�.. ��U 4 � :�V . 4� � T,i, ° a�i a� � c � �'�--'.S. o � � � � � fx a�'i� a. F� m a � :� G� �. � �.� � ? � ..� � � w �F.. � - .� °� � � �� .,� ,�. : � y � _ `z' � ,s; .� --� � g� O' � � �� ?� ou� d � � � 0} R � s �> � � �- 3 m . � ~ � ��Q Q .�.. o .r � � ^ �a � � L w a, ca-Ms � : U r � �� ttl� � . . . � . � �y� �N� �. � V �� . . Vi �'sY 2 . m . >'� II3 � - � � � � Q �3 3 ; � �:`� �. ? ,� 8�0 -�� ca -a c � n.'.� O+�+ � c� a�ya' aWt�t 3 .0.� m q y C, A � � � � > � >,� � fl � i�o U s ��'� p� �al�aa� � � � �' ° � .�' � �� Qo � � zQ � v �� r.�i� � � .'y.°. �,O � aa �� t�t � � � X �.�C � � N � _ � � F•f-� - � 4 � � � 06I03��415 12:42 Saurce Construction Capital �A�7635514999 P.042l404 Use BLUE or BLACK Ink �---------------- 1 For Otfice Us� !�� Permit#: / � h f �It�[ Of�� ; . . � q�,� ; Perm�t Fee. � 3830 Pilot Knob Road � Eagan MN 55122 � Date Received: � Phone:(651)675-5675 � � Fax:(651)675-5694 I 5taff: I I � _��.��_��J 2015 RESIDENTIAL BUILDING PERMIT APP�ICATION Date: 1��J ��s Site Address: l0�J �/1<� ��i'j0� �D2� Unit#: �,..�,,..�,.,.�,,,,�,.�.��:�,�.., �.�._.. ..�,� ..��..a.v....� � -� Name;__ �Q r� ��$� �.�.G Phone: �fo.3• ��'�!`�� R�'S1C�l.'11Y/ ' u ,�.,,," �1 /� $ ` OWitQ� ° � Address/City/Zip: I�f}� S �t S�' /! r� l� ��j'C. .I� 1�`Nl1ZU J�j �J7'/� ��a � � , � Applicant is� Owner Contractor m� ��=.�Y�.,Y� , , . . �._� �; ; s � �l(lYld��` � 3 Description of work: ��DIIT/p� � Z d�I7'bvl �CK�7 S cM ��brj$ � Type of Work ; : � � .�� _:�y_�� 9'� � � `, � Construction Cost: Multi-Famil Bwldin Yes � /�No�Y� II � ; � Company: Mir / doU �!'� L�e. contact: i'a�' ��tQ.l�' . I S �:.;..' � Address; C011'tlaCtQ� . City; t ,..� � �— Phone: ��i 3'�'�'�9lEmai�: ,9�.J�'G��/Ifd✓7�iL.GtO?4rtll•C'q� � , , '. � State: Zip: 1 �.:: � License#: �L 63��'� Lead Certificate#: � If the project is exempt from lead certification,please explain why: �k�y.��'ntt�~�':.: COMPLETE THIS�AREA ONLY IF CONSTRUCTING A NEW BUILDING T� In the last 12 months,has the City of Eagan issued a permif for a similar plan based on a master plan? � a Yes No If yes,date and address of master plan: � f Licensed Plumber: Phone: � � Mechanical Contractor: Phone: � � Sewer 8�Water Coniractor: Phone: F Fire Suppression Contractor: Phone: � �..._...� ;f��NOTE:Plans�and supporting alocuments that you submit are con�idered to be public information...Portions of � the inforrt►ation may be classified as non:public if you provide sp;ecitic reasons that would permi.t fhe City to p �„_�._ w�,._�._.__�,µ�..��.._,.AM� �� concJude that they are trade secrets. ° .. �y.� .,,�......,.��,....�e..._�,..,_„��,.,.,...,...�.,.,.......�s..,�...,�.,_...v,..._.a,_,.,_.,....�......M...�.,..,� CALL BEFORE YOU DIG. Call Gopher State One Call aE(651)454-0002 for protection against underground utility damage. Ca1148 hours before you ir�tend to dig to receive locates of underground ufilities. www.qopherstateonecall.om I hereby acknowledge thai fhis information is complete and accurate;that the work will be in conformance wiih fhe ordinances and cades of the City of Eagan; that I understand this is not a permii, but only an application for a permit, and wor9c 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Buildin 'm�e compteted within 180 days of permit issuance. x ��"riC,� �l�l�C•r X Applicant's Printe�i Name Applicant's Sig e Page 1 of 3 � � � r � , ;��; Minnesota Poitution nm� w;- ControlAgency SSTS Abal�dO .nt � ^ 520 lafayette Road North Re po rt i n g Fo r m St.Paul,MN 55155-4194 Subsurface Sewag� Treatment Systems (SSTS) Program) Instructions This form is offered to meet the abandonment requirements of Minn. R. 7080.2500 and Disclosure Requirements of Minn. Stat. § 115.55, subd. 6. Future water supply well placement can also be affected by an abandoned SSTS. The use of this form is not mandatory; however the information on this form must be submitted to the local government unit(LGU) within 90 days after the abandonment. This form may be completed by a certified SSTS practitioner or by an individual who has direct knowledge of how the system was abandoned. Property Information Date of abandonment: � '��Reason for bandonment: l��' �U!�� ''� ��-�� '� �� °�l �r�-� Prop rty owner na e(s): �:"` � !�y Property owner's dress: a�`/�`'�� `J ' ,� •� City: r 1'�119� Stf�e�: � Zip: �S '� Site address(if different): �D � f> h ah /`y�' • CitY: � �%�Ef=r State: /�� Zip: S5/�� Compliance Information 1. All solids and liquids re oved from all tanks? [�Yes ❑ No �q Disposal Site: �1+'� � c✓ tn _� _ (� �� " �� ! � �� / 2. All electrical devices and devices containing mercury removed? �Yes ❑ No Disposal Site: 3. All underground sewage tanks crushed and filled with soil or rock material? Yes ❑ No or Removed and disposed off site? ❑Yes ❑ No Disposal Site: t � 4. Contaminated materials*removed and disposed off site? ❑Yes ❑ No Disposal Site: �� 5. All underground cavities**crushed and filled with soil or rock material? [�Yes ❑ No or: Removed and disposed off site? ❑Yes ❑ No Disposal Site: �'� 6. Future discharge to system permanently denied? Yes ❑ No Method(s)used: /"p�jg�►f� �� '�g hr:� �'" *Contaminated moterials= Distribution media,soil or sand within three feet of the system bottom, distribution pipes,geotextile fabric/rosin paper/straw, tonks, contaminated soil around leaking tanks, any soi(that received sewaqe from a surface fQilure(7080.2500 subp.3). ""Underground cavities= Cesspools, teaching pits, drywe(ls, seepage pits, vault privies,pit privies, pump chombers (7080.2500 subp. 1). Does not inc(ude chamber media, drop boxes, or distribution boxes. www.pca.state.mn.us • 651-296-6300 • 800-657-3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-03 • 11/21108 Page 1 of 2 , � � P � Map Include location of building sewer, septic tank(s), soil dispersal system, cesspools, seepage pits, and other pits. Also include a permanent reference point(s) and dimensions. T North � � � � ( I '`�l� �� I� � � � � � � � � �� .�� - . � �-.� S G-/� ` � � \ I � ''` I f� � � � � � � � � � I � I I ��.:� Q ��,' �i� � ��„r I � � � C��`�� Certification l hereby certify the syste �as abandoned'n acqordance with Minn. R. 7080.2500 and any local requirements. Name(please print): y� �(��/'1'!� Title: _ �/'��` � /� /� Address: g � ` �' CitY: ` ��} c� State: �"1 Zip: �}C�7� Phone: � �� '� Licens #' pplic le): � Date: _.�� — _ Signature: www.pca.state.mn.us • 651-296-6300 • 800-657•3864 • TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-03 • 11/21/08 Page 2 of 2 __ __ _ __ _ LaVERNE'S �;�� PUMPING SERVICE �r , 24345 Highview Avenue LAKEVILLE, MINNESOTA 55044 952-469-2489 DATE��!I S PY✓L G. v/ 47 T � I ✓�", . NAME ({ y � l �b V♦ ADDRE S ��q <'4/ � 4 +�.�/ CITY /�C'� � `�� 4 � • �•♦ o . � � _... ... ___ .. _ . _____ ` _ �,it�.� ��-� __ _, __ .__ ' _,_� _ _ ___ _ _ __ - --__ . __�f�� °�o�f-_ �'�__. _ __ _, . _ � ,� � __ __ -__ ___ _ _ __ _ � �� -+----- ^late payment ch8rgs of$5.00 wil�be atlded to ihe unpaid balance of accounts over 30 days. �an��Ou 13967 fi��.NC:G'!2?E�JUl:i' Claim Voucher ' City of Eagan , Date : 9/23/2015 , Make check payable to: Larry Stubbs ', Add ress: 2284 County Road 90 � Maple Plain,MN 55359 I Refund Escrow of 2 000.00. Permit#129274 Finaled Out 7 13 2015 II! $ , �-(�� ,`I a� f�n�b i��• �I Total Refund: $2,000.00 Project Number : Permit#129274 *Please sign to release remaining escrow balance. S gnature Sarah Brandel