1795 Serpentine DrCITY OF EAGAN Remarks Sew & wtr permits and Sew corm pd. on L-4-69
Addition Cedar Grove #6 Lot 9 wk 4 Parcel 10 16705 090 011
-?ke 14
Owner
1A . L,
9 L = street 1795 Serpentine Dr. State Eagan,MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL 970 1472.00 20 Paid
WATERMAIN
WATER LATERAL O
20
WATER AREA
STORM SEW TRK 1970 20
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 200.00 1291, -10-6
BUILDING PER.
SAC 200.00 1294 - -
PARK
EAGAN TOWNSHIP
BUILDING PERMIT N°• 1975
Owner ?'
.................. /...... ...................... ....-?----------------- Eagan Township
Address (present) .------ Town Hall
Builder ....................................... ..........---...__.............----......_._..-.- i
Address Date ... ... ....--
LOCATION
street, ttoaa or other Uescrtptlon or location Lo! Block Addition or Tract
i C,
/, y
lee
This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, that ... .:......:......._......-...........-...-................ has permission to erect --------- .........-.. on
the above described premise subjee! to the provisions of the Building Ordinance for Eagan T wnship adop ed April 11,
1955.
.......'--........ ..... .. L ....................... ?-
-:. Per ............. ...._,.(_&!..._.(!.'r`'4.:c y....../....
Chat an of Tnwn Board ------- _.. .
Building Inspector
G - IS
Cities Di
r Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
Citu of Eagan
Cash Receipt
Receipt Ste 3/31/288v
Receipt k Ober 84547
ONIS No
DRYCAR: 145°EC 10N
1281.4216 51.68
1795, 5'RPENTINZ DRIVE
Total Rece:pa Amount SAO@
:17342 1::46112
RESIDENTIAL BUILDING
2-o L? Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
ef--,a
New Construction Reguiements Remodel/Repair Requirements Office Use OnN
3 registered site surveys showing sq. ft of lot, sq. It. of house; and all roofed areas 2 copies of plan _ Cart of Survey Recd
(200h maximum lot coverage allowed) 1 set of Energy Calculations for heated additions -Tree Pres Plan Recd
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks _ Tree Pres Not Reqd
1 set of Energy Calculations Addition - indicate if on-ske septic system - On-site Septic System
3 copies of Tree Preservation Plan if lot platted after 7/1/93
Rim Joist Detail options selection sheet (bldgs with 3 or less units
Date )(D_ / C-) I / Q? Construction Cost
Site Address ( - G) 5 l¢,- Unit/Ste #
Description of Work I?r
G I C4 Q
Multi-Family Bldg - Y ? N Fireplace(s) _ 0 1 - 2
Property Owner h I (l hY P g0 "s" t,3 Telephone # (c s l) 45y - 2 (,b cA
Contractor a0e0Fiae1°e
dhn 9-,1M we rMir Wne
Address License 11200909//
2laa N F ' ew AVe
City
State Roseville, MN 55113
6511633-2561
Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
tU 00 ?
O T 2 2 2003 11111
Telephone # (
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the appr d Ian in the case of work which requires a review and
approval of plans.
&rlS?- P, WZ- -1w??'c ? 1aYa
Applicant's Printed Name
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi
? 03 01 of- plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED I NSPECTIONS
Footings (new bldg) _ Final/C.O.
- Footings (deck) _ Final/No C.O.
Footings (addition) _ Plumbing
- Foundation HVAC
- Drain Tile Other
Roof - Ice & W ater _ F inal Pool
Ftgs
Air/Gas Tests Final
Framing -
- _
_
Siding
Stucco
Stone _
- Fireplace - R.I. _ Air Test _ Final _ _
_
Windows (new/replacement)
Insulation - Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
.n'ItS%kfi.:ici'SYR$f^.?.u?M M??IyW. ry.µ?i??' '.?T.1 /,C%F%$*n7N%??C ;bSKtn"M'7A'
CI fY 6,v EAC^AN
L:f:SHTEX%t Jn rETWINAL. hl`-. E89
RATE: TI iE.. 09.Of?i24
t•W"E VASTER REMODELING, ;:K..
2W 9901 7795 SERPUTI:N 97.25..
205 9001 1795 BE:RPENWON 2.00
Total. feceaipi Amount: . 99.25
CWWO
USER ; r „ -WA
`n?%?iC?i7t*•J,S;@Yi*.?%k?k?c?7kvrR?? #.Y,.;krtgc$;)g7$:x%:,1X7%?t'7B%?%:%?*sk?"
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN Qc? Z?
3830 PILOT KNOB RD - 55122 /
651-681-4675 l U - a ( ?j
New Construction Reautremenh Remodel/Repair Reaulremenh
D 3 registered site surveys showing sq. ft. of lot, sq. ft. of house
and all roofed areas (20% maximum lot coveraae allowed)
D 2 copies of plans (show beam f: window sizes; poured intl. design; etc.)
D 1 set of energy calculations
D 3 copies of tree preservation plan it lot platted after 7/1/93
DATE: I zo l 4 J
Name: M-fo ltr5514 A'71 )J<fA/454*-)Phone#: GS1 3&01
Last First
DESCRIPTION OF WORK:
STREET ADDRESS: P%2"IJ M z2k?
?r en
LOT. l BLOCK: SUBD./P.I.D. #: C L C ?x ? G V C)
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Street Address: /747.5--
45State: !-J,?/l) Zip: ?5 /ZZ
city
MASTER RF1v1C -,:i..: .
Company: 32 Tenth Avenue 5 Phone
HOpkins, Minnesci_ (area code)
(612) 9? -? _ a 1
Street Address: License # 2-a12916, Exp. 7014
City
2 copies of plan
1 set of energy calculations for heated additions
1 site survey for exterior additions R decks
CONSTRUCTION COST. . i?'D
State:
Company: Name:
Telephnne #: nran rode t
Street Address: Registration #:
City State:
Sewer 5 water licensed plumber (required for new construction only):
Penalty applies when address change and lot change is requested once permit Is
I hereby acknowledge that 1 have read this application, state that the
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant.
OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No Not Required
Zip:
Zip:
comply with all opplicabl
RECEIVED
OCT 21 1999
BY:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
P-02 SF Dwelling . ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only 0.43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg.* ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair n 38 Derno!iQ', /1r40rinr? r] 41 Deroof
* Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SAM Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
q of .
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
- Engineering Variance
Valuation: $ Lf?
SAC Units
% SAC
MEMO
TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECH
DATE: AUGUST 25, 1993
SUBJECT: STREETLIGHT ENERGY COSTS
CEDAR GROVE NO. 6 (141 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 6 Addition
as listed below:
Block 1, Lots 1 1
Block 2, Lots 1-8 8
Block 3, Lots 1-18 18
Block 4, Lots 1-11 11
Block 5, Lots 1-9 9
Block 6, Lots 1-53 53
(Lots 54 through 61, Block 6, should not
be billed at this time)
Block 7, Lots 1-12 12
Block 8, Lots 1-18 18
Block 9, Lots 1-11 11
TOTAL 141
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
Ed Kirscht
Sr. Engineering Tech
cc: Mike Foertsch, Asst. City Eng.
EK/je
E
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: .1 ? z Numbers 2$
Billing Name: Site Address: -?
owner:Zjk ? z ,//
sa [?. Billing Address
Plumber:
NO I Total Chg.
Meter Size-???
Meter No?Pi G yam Permit Fee 7.50 Pd.
Meter Reading`-..tJ Meter Dep.
Meter Sealed: Yes 'Add'l Chg.
Inspected by
Date
Building is a: Remarks:
Residence
Multiple No. Units
Commercial
Industrial By:
Other Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County Minnesota.
By: -
Please notify the above office when ready for inspection and connection.
EACIM TOIWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE CONNECTION
DATE: 7 /y?L q NUMBER. 369
OWNER, Address 9'y ?7?5 et® ?i
PLUMBER TYPE OF PIPE CMG (/?/?[/
DESCRIPTION OF BUILDING
Industrial) Commercial Residential i Multiple Dwelling No, of units
Location of Connections:
Inspected by:
Date
Remarks:
Plea notify when ready for inspection and connection and before any portion
of the rk is covered.
Connection Charge 200.00 pd.
Permit Fee 7.50 tea.
Street Repairs
Total
$y
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Toemship, Dakota County, innesota
By
00 pq
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan NM 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements
3 registered site surveys shoving sq. R. of lot, sq. ft of house; and all roofed areas
(20%madmum lot cwerage allowed)
1 Soils Report if proposed building is to be placed on dishubed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan Blot platted after 711193
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
RemodellReoair Reauiremen
2 copies of plan slwwing footings, beams, joists Certof Suriey Recd `:,' :.- Y. "..N
I set of Energy Calculations for heated additions Soils Report.,. _Y -N
I site survey for additions & decks Tree Pres.Plan Recd - -=y` -_N,
Addition - indicate H on-site sepfk system Tree Pre; Required, "Y.. _N
on-site Septic System _?Y _N -
Plana arp cnnaidprad nubile information unless you state thev are trade secret and the reason.
Date le 1 l o Construction Cost 6 000
Site Address fojrry TT /U £ jZ . Unit/Ste #
Description of Work ?2 - IZ oo F
Multi-Family Bldg _ Y - N Fireplace(s) - 0 - 1 _ 2
Property Owner
gz
ii•-) (
?' LtL $a Itl , IK
A v? Telephone # ( 9?177)
Contractor ( L r>R E ?Jus Tj e
Address 3 y 4& 274- L AV, City ?d9 r/y9G? .
State /yt fU Zip X5-3715' Telephone # fiCe
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category • Residential ventilation Category 1 Worksheet New Energy Code Worksheet
(J submission type) Submitted Submitted
• 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?
- Y - N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work 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
Telephone #(
- o?? ?? -
App scans tatur
DO NOT WRITE BELOW THIS LINE .
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 - Porch (screen/gazebo/pergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Demolition (Entire Bldg) - Give PCA handout to applicant
Description: Water Damage`Yes
Valuation Occupancy MCES System
Plan Review 100% or 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
- Footings (new bldg) _ Sheetrock
- Footings (deck) _ Final/C.O.
Footings (addition) _ Final/No C.O.
_ Foundation _ HVAC -
_ Drain Tile Other
Roof - Ice & Water _ Final - Pool _ Figs _ Air/Gas Tests _ Final
_ Framing - Siding _ Stucco Lath _ Stone Lath -Brick
_ Fireplace _ R.I. - Air Test - Final _ Windows
Insulation _ Retaining Wall
Approved By: Building Inspector .
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Use BLUE or BLACK Ink
I For Office Use I
I I
I
City of E a~(~ 7~liitli Il I Permit _ I
I ,h
Permit Fee: 1 d7 3`S~
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
7 /_O Site Address:
Date: Unit
Name: Phone:
Resident/
Owner Address/ City/ Zip:~~
Applicant is: Owner Contractor
Type of Work Description of work:
Construction Cost: / Multi-Family Building: (Yes / No )
- L~
Company: Contact: //®I
Contractor Address: City:
State: M+ °Zip: Phone:
~
License 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: I
I
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone: j
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe classified as non-public if you provide specific reasons that would permit the City to
i conclude that they are trade secrets.
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.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
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.
Applicant's Printed Name Ap icarit's Signature
Page 1 of 3
Use BLUE or BLACK Ink
I For Office Use I
I I
City 1 ~a Permit#: of I
I Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received: wo L13
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: , lf"/r tl 3 Site Address: Unit
Name: Phone:
~a
Resident/ /
Owner ` Address I City / Zip:7
Applicant is: Owner Contractor
Type of Work Description of work: 1;"P: AJ t1,
Construction Cost: Multi-Family Building: (Yes / No )
Company: Contact:
Contractor Address: City:
State: Zip: Phone:
License 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:
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.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minn esot ate Building Code must be completed within 180
days of ermit issu
x x
Applicant's Prin a Name A p icanf Si ature
Page 1 of 3
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
JUN 2 0 2016
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
6."(
Date Received:
Staff:
2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
Q -' O✓11,[ Site Ad
Address: 18.01 5 0thS t East
State: Mn Zip: 55077
Phone: 651-451-2241'
Contact: William R Milbert Email:
License #: r C641376
City: Inver Grove Hgts.
_ New Replacement _ Repair _ Rebuild _ Modify Space _Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Lawn Irrigation (_, RPZ / PVB)
_ Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures (_ Main / _ Lower Level)
Water Tumaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
"Water Turnaround (add $200.00 if a 5/8" meter is required)
$115.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) , O O f
TOTAL FEES $ ,
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 digit', receiv"e'locates of underground utilities: www.000herstateonecalLoro
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 epproved plan in, the case of work which requires a review and approval of plans.
11 x
Ln
? /i
Applicant's Printed Name Applicants Signature