Permits - Permit# 408 - 2444 Black Lake Road - 1/1/1978, count Na" ` �/� APPLICATION 0R .PERMIT I Permit No
I VI �.. VII II�a. 11 VII • �• - — Water --'-
Water
Village of �---- J
51-
Spring Park, Sewer ---- Sewer
Minnesota Meter Deposit.S
Total
Prope y Owner
Name
Address
Telephone
Contractor
Name
Address
Telephone ��— ����g
Permit No. - Expires:
To Be filled out for Both Sewer or Water
Legal Description of Property Plot 4-?06s Lot Parcel y�e0 Block Add.
Has Assessment been levied? Yes No /
No. of Building or unit to be served. Water le Sewer
Type of Building: Res. Comm'I. Indus. Other
Are Water and Sewer to be installed in same trench? Yes No
Is there Basement Under Bldg? Yes No Full Partial
Water
Use of Water. General
Approx. Mo. per year to be used
Size of Service Required:
Point of Entry to Bldg.
Meter Location
Special
The Undersigned hereby agrees:
To notify the Inspector when work is ready for
inspection, and not cover any work until such
inspection is made and the work approved.
` f
tract.al,� ..
APPROVED BY
Remarks:
�U
Sewer
Are all buildings properly vented
Service Pipe: V. Clay Cast Iron
Size Length
Point of Entry to Bldg.
Kind of Joint Used
Is Pretreatment Required? Yes
AFFIDAVIT
No
By signing this application, I do hereby declare that
all Statements herein contained, are true and correct.
That all work for which this. application is made will
be performed in accordance with applicable Ordinance
of the Village of Spring Park, the State of Minnesota,
and the rulings of the Public Utilities Department.
If at the time this application is made, the Special
Assessments have not been levied, I do further con-
sent to the spreading of the pro -rats assessment
against the described property.
Date
Owner
1b
FORM 5W 1
Poor Quality Document
Disclaimer
The original or copy of a document or page of a document
presented at the time of digital scanning contained within this
digital file may be of substandard quality for viewing, printing or
faxing needs.
J
-PARK -
• O:$
ADDRESS
• - •Zyffm.,FAWW MT
STREET
4349 Warren Avenue
Spring Park, MN 55384
BUILDING P APPLICATION
',d / &I
of- A,/"_
TELEPHONE
TELEPHONE JO
r—
EST. COST
PLAT (�G'�I D(!�. PARCEL �00 ZONING
COMPLETION DATE
Aunlication requirements
Survey ..........
Energy
Comp....... Heating
Layout..........
Plat Plan .......
Elevations
........ Sewer -Water Location....
Structural Plan... -�
Watershed.......... County
Driveway Permit...
Other
Types of Construction
NEW CONSTRUCTION
REMODELING
Single Family
Sq. Ft.
Addition
Sq. Ft.
Multi -Family
Sq. Ft.
Interior
Sq. Ft.
Commercial
Sq. Ft.
Sub Level
Sq. Ft.
Industrial
Sq. Ft.
Roofing
Sq. Ft.
Garage -Size
Sq. Ft.
Siding
Sq. Ft.
Deck -Size__
Sq. Ft.
_„Utility Bldg.
-Size
Patio -Size
Sq. Ft.
Sq. Ft.
Fence -Size
Ln. Ft.
Plumbing
PERMIT FEE $ (.17U
PERMIT APPROVAL
SURCHARGE $
PLANNING COMMISSION
S.A.C.
COUNCIL
AVAIL. CHG. $
OTHER $
�r��
ylly/.Ig
Total $
In case permit is granted, I hereby agree to do the proposed work in
accordance with description above set forth and according to the pro-
visions of all ordinances of the City of Spring Park and of all statutes
of the State of Minnesota in such cases made and provided.
DATE VV w'? APPLICANT