6150 Deer Ridge4;
SEWER, WneZR OR COi4BTN?TION SLRVICZ FORM (CIRCLE ONE)
Municipality CHANHASSEN Service No.
:crr'rvawiN t � Sheet No.
Street r d�3P House No.
Lot _Z (� py� Block t Parcel No.
At:.. .. -c. 1..leLe p I1li�a�
Down Sream. Ma:-...c_e No.
Sta. a: ... p.:. _r. Do nstre_am Manhole Z�ZZ 4lty Z -" �f�b
Eje C.L. of Sewer Main
Tcr rc = -cn -- evasion Dec of Basement
Dec c! Clean -Cut Clean-Out Elevation
Distance fr - - :n Sewer Main to Clean -Out
of Grade fcr Service to be Installer
(if , grade service)
L•er_t 1. , size an= ty - e of service pipe G
Dep P.L.
,.; t --�
Downstrea- man..., :e No. 2-
Sta. at F.L. fr -- Downstream Manhole
Length siZe and ty p e of service pipe
Decth a= P. -. ?,5
Deenctas sewer service end
° Denotes crater service end
gl
Con tract.. �aLtl
Tied t: -i
Fcreman lea
Date
Location and de =th of services certified by
Date
ROTE:
r
REV SED 2 -93
Servic: ties shall be swing ties to permanent structures such as building
corners, valve boxes, manholes, catch basims - hydrants, etc Ties to trees,
power-poles, property corners, telephone or utility boxes will not be accepted.
CITY OF
OAT=_ 2 - 9 1 1
s
PLATE NO. 5221