6195 Deer Ridges .
[11
SEWER, FATZR OR C0r4BItlAT'_ON SERVIC 7OR11 (CIRCLE ONE)
Mun icipa lit CHANHASSEN Service Pao.
.crTyMW'M Sheet No.�
str {° kt a e House No.
Lot 5 Block Parcel No.
Add-r.-'c. Derr R;da'-
SE I -IFF
Dc�,str Man'—o__ tic. 2 �®
Eta. at P.-. from Downstream Manhole
- _evat_on at C.L. of Ses-ar Main
,cc = c:.. dam_cn d- e:•a_ion Deot o. Basement
Dept c= Clean-ClUt Clean -Out Elevation
Distance from Se"aer Main to Clean-euz
� of Grade for Service to be installed
(i_ r.._ri- Er ade service)
L•er size a- ty=e of service pipe .6 �� P�L
De= at
;.; -'-'
Dawnst=eaa man.. Nc. HX
.Sta. at F.L. -_ DcWnstream Manhole O �_� M
m
Len ;t::, size a -v t —e of ser'''ce p ,.pe ''
Dec - h at ?. G
Denotes se+»e= service end
:enotes crates service end
' 133,
100.,
,2 ..5
co STI 2
r
Ce ntractcr nn L� � } Foreman (
Ties by Date
'P
Location and depth of services certified by
Date
NOTE: Service ties shall be swing ties to permanent structures such as building
corners, valve boxes, manholes, catch basins, hydrants, etc Ties to trees,
power t oles, property corners, telephone or utility boxes will not be accepted.
CITY OF
,_ 4 fi
REVISED 2 -93 DA
PLATE NO. 5221
t