1438 Balsam St - Tie In Card _ 3795 p S I Road
1. St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Date: ieYre,ry 19 I977
Number:
Billing Name:j`ilssr cou
tructi n C... ,
Site
Address e: v, , :; t �
Owner: sn.�,.: ,,.,��: . .
Billing Address
Plumber: Lueci.._ <, 'xc.v4tic.:
Location of Connection
Meter Size Connection Chg,.- 2/1V71
Meter No.
Permit Fee lo_ 0 ;1 Vi ,.71
Meter Readi
n%______ Meter Dep,
Meter Sealed: Yes ,
9 Ada 1 Chg.
NO Total Chg. --
Inspected by______
--Jr11/ Date ���y
Building is a: 7�
Remarks:
Residence -,,,
Multiple No. Units
Commercial $25.06 i E- itISPECT!ON FEE FOR
Industrial IMPROPERLY INSTALLED METERS.
Other
By:
�.... Chief Inspector
In consideration of the issue a
hereby agree to do the and delivery to me of the above
erebyta to pro work in accordance with the rules and I
Eagan Township, Dakota County, Minnesota.
v
BY r' • s t qq
1 .A.cavutiui
lease notify the above office when ready for inspection and connection.
i
