City of Maple Grove

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Excavation Permit Utility Installation Permit No. 2021-EP007, UID # 4270
App. Status: Returned for ChangesCity of Maple Grove
Engineering Department
12800 Arbor Lakes Parkway
Maple Grove, MN 55369

Kelly Matzke (612-968-3615)
 

APPLICANT

Applicant:
Name:
Kelly Edward Matzke
Company:
City of Maple Grove
Company Phone:Local Phone:
(763) 494 - 6365
(612) 968 - 3615
Email Address:
kmatzke@maplegrovemn.gov
Mailing Address:
12800 Arbor Lakes Parkway
Maple Grove MN 55369
Additional email address to notify:

CONTRACTOR

Contractor:
Name:
Kelly Edward Matzke
Company:
City of Maple Grove
Company Phone:Local Phone:
(763) 494 - 6365
(612) 968 - 3615
Email Address:
kmatzke@maplegrovemn.gov
Mailing Address:
12800 Arbor Lakes Parkway
Maple Grove MN 55369

PROJECT

Nature of Work:
Main Installation
Surface to be disturbed:
Boulevard
Work to start on or after: 01/01/2021
To be completed on or before: 12/31/2021
Applicant Project No.: TEST

INSTALLATION / CONSTRUCTION

Provide a detailed work description: 
TEST
Attach detailed plan sheet:
Size and kind of pipe: 
TEST
Depth from surface: 36"- 48"
If other is selected, please provide additional information:
Length of utility construction: 100
Method of installation:
Directional Bore
If other is selected, please provide additional information: 




Development:
New



Attach letter/door hanger used to notify property owners affected by construction:

    		

    

    

    
	
    

    

    
	
    LOCATION
    
	
    

    Location/Address:
10622 Lancaster Lane N.

    

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    TRAFFIC CONTROL
    
	
    

    Will traffic control be necessary?
No

    

    

    
	
    

    

    
	
    Invoice #3752 (01/21/2021)
    
	
    

    


    
	
	Charge
	Cost
	Quantity
	Total
	

    

    
	Non-Taxable

    
	
	 added 01/21/2021 2:11 PM
    Excavation permit fee per occurance
    		
	$160.00
	 x 1
	$160.00
	

    
	
	 added 01/21/2021 2:11 PM
    In addition to excavation permit fee (per lineal foot)
    		
	$0.20
	 x 100
	$20.00
	

    
	Grand Total

    
	Total
	$180.00

    Due$180.00
    This Application has not been submitted, so you may not pay for this Invoice.
    


    
	
    

    

    
	
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      Internal Notes
      
	
      

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