3905 Pilot Knob Rd .L y W ATE R - SER PERMIT -
�F PAGAN . A
` , Pilot Knob Road DE RMI T NO. ' '
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a MN 55 22 D ^. r ]
Zoni t v k No. `of Units
,_,-.„ .t: ,e. t ; _
Ad ss
Site ddre "' t,:
1
- M e ter ,. � ' - Account : Deposit
C ie, t . at` 1 ;, .
Render Flo = `, Permit Fee:
4
'' 1 agree t c omply " with ,the City o f E agen ' ' Surcharge
Ordinances. Misc. Charges: ;`'
Total:
g Date Paid: t s
Date of insp.. `/ -. . lnsp ,f �, _ .+
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