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3810 Sibley Memorial Hwy s 4 -' , . ' R I r e *A Rood PERMft� 110:: , 55122 DATE: " Ong; No, of ()tits: I e Qwner: r*.ii -r P.ty. ! Site Address: Meter No.. , Connection Charge: ; Size: Account Deposit: Reader No,: r Permit Fee: 1 oleos to cositply with the City of Eagan Surcharge:. ; ordle noes. Misc. Charges: ) s , 4 , ' Total: ' ;r By Date Paid: Dote of Insp.: /rte / �? , Insp.: