Permits - Permit# 26-02 SEWER - 4325 Channel Road - 10/16/2026 Sewer & Water Permit Application APPI a IN d a se
4349 Warren Avenue.* Spring Park,MN 55384 $ ano-10� •
0952-999-7493, khoffman ri J t�sp ng-park.mn.ua
REV:IrXV2020
SITE ADDRESS OR SUBDIVISION,LOT AND SLDac sturTE DATE
LOT BLOCK
PROPERTY OWNER
APPLJCAM 94001MATIMI
Applicant Is: 0Property Owner tractor []Tenant ANY NAM
N STATE CE
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[]Commercial DMult-Family esidential ❑Church ❑COmmarcia []Industrial []Other []Public
[]New Building OR Q61sting Building []Multi-Famwmgle Fam Dot []Townhouse []Two-Fam
DOW Deeeriptlorh of Work:
aW
[]Principal Building 'Jiagony Building []Other INIMMINd
RSi~&Water Connect I []Sewer&Water Repair
&Water Connect []Sewer Connect ❑Sewer Disconnect
[]Sewer&Water Disconnect []Water Connect []Water Disconnect
pelawrOMMOM
Residential Commercial J industrial
Sewer Connection or Disconnection $40.00 Sewer Connection 1%of Job Cost,$40.00 min.+
$1.00 State Surcharge Fee or Disconnection .0005 State Surcharge Fee
Water Connection or Dlaconnedion $40.00 Water Connection 1%of Job Coat.$40.00 min.+
$1.00 State Surcharge Fee or Disconnection .0005 State Surcharge Fee
Sewer and Water Connection or Disconnection $80.00 Sewer&Water Connection 1%of Job Cost,$80.00 min.+
$1.00 State Surcharge Fee or Disconnection .0005 State Surcharge Fee
Sewer&Water Repair 1%of Job Cost.S40.00 min. Sewer or Water Repairs 1%of Job Cost.$40.00 min.+
.0005 State Surcharge Fee .0005 State Surcharge Fee
Plan Review Fee for Private $100.00
Underground Uti ty Installations(when required)
Appliant/hate svad and Sign below
I hmeby ov*Cat I he"road and examined this dooxnent and know to same to be hue and oared I cnderitand and agree that Ia wolk for wAhicn to pem*is issued
,hell be performed scoording to to appiiceW city approvals,ordinary and codes.I further certify that I an to owner or t*owners sutrorized agent and tat to
proposed work is suftnzed by to owner.I understand that the work shd not begin untl permit is issued.that i am responsible for calling for al reM*W in,pectona,that
work steal be accesafbb for the kispecton.This perndt shall becarhe Wald wim to work authorized Is commenced*VM 180 daft efts is lssu im,0r t to work
a noted by such permt Is suspended or aboKkx d for a period of 180 days. '3eparasa WOW exemadw parndts awed bo obtained for straat cuts'
DATE
WEs Y
DATE RECEP.W AUTHORIZED TO ISSUE: rtAAR1t3:
10
[]Plan Review Underground Utility []MCES SAC Sewer Rec Water Rec []Water Area []water Lateral
CommiInd.
Jamie Hoffman
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Sent: Friday, October 16, 2026 8:33 AM
To: Jamie Hoffman
Cc: payment@thepaymentgroup.com
Subject: DALE CAZETT Permit Payment to Spring Park, MN - Permits & Licenses from TPG
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Dear Spring Park, MN - Permits & Licenses,
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Date Paid: Friday, 16 October 2026 08:32:47 CT
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METRO
DALE CAZETT GENERAL SAINT MICHAEL L1546 $100.00
SERVICES
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