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<br />I. <br /> <br />MINNESOTA DEPARTMENT OF HEALTH <br />Division of Environmental Health <br />Section of Water SupplY a~d Well Management <br /> <br />PLAN REVIEW FEES <br /> <br />PLEASE READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING APPLICATION. <br /> <br />1. Answer all questions in full. <br />2. Application must be complete <br />and fee submitted before plans <br />will be reviewed. <br />3. Checks should be payable to the <br />Minnesota Department of Health. <br /> <br />MAIL TO: Minnesota Department of Health <br />Section of Water Supply and <br />We 11 Management . <br />925 S.E. Delaware Street <br />P.O. Box 59040 <br />Minneapolis, Minnesota 55459-0040 <br /> <br />~xu PROJECT TYPE(S) AND FILL IN TOTAL FEE SUBMITTED. <br />(Fees are additive for multiple project types included on one set of plans.) <br /> <br />(X;g Watermains <br />[ ] Well <br />[ ] Pumphouse <br />[ ] Chemical Feed <br />[ ] Treatment Plant (new) <br />[ ] Treatment Plant (renovation) <br />[ ] storage (installation) <br />[ J Storage (coating) <br />[ ] Booster Station <br /> <br />Total Fee Submitted <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />$. 150.00 <br />$ 250.00 <br />$ 150.00 <br />$ 150.00 <br />$1,000.00 <br />$ 250.00 <br />$ 300.00 <br />$ 100.00 <br />$ 150.00 <br /> <br />$ 150.00 <br /> <br />Office Use OnlY <br />Plan No. <br />Fee Type <br />Deposit No. <br />Deposit Date <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />* <br /> <br />PLEASE TYPE OR PRINT THE FOLLOWING REQUIRED 'INFORMATION. <br />Name of Project: Hills of Owasso Project <br />Project Location: Roseville <br />City (if not incorporated, township) <br /> <br />Ramsey <br />. County <br /> <br />Owner's Name: <br /> <br />RosevilTe School District 623 <br /> <br />Owner's Address: 1251 County Road B-2 West <br />street <br /> <br />Rasev; 11 e <br />City <br /> <br />MN <br />State <br /> <br />fi!i11~ <br />Zip <br /> <br />Submitter's Name: <br /> <br />Schaell & Madson, Inc. <br /> <br />Submitter's Address: 10580 Wayzata Boulevard, Suite 1. Minnetonka. ~N 55305 <br />Street City State lip <br /> <br />Submitter's Telephone Number (612 <br /> <br />546-7601 <br /> <br />#56 <br />