3965 Beryl Rd - Tie In Card 4-3-
EAGAN TOWNSHIP
3795 Pilot osota55
St. Paul, 55111
Telephone 454 -5242
46,- eisitai-"totAet ER SERVICE CONNECTION NUMBER s
DATE• ` ` n ✓t, 3 r it, c ! 1 !!/
OWNER:
,�. Address fir ",s i%
TYPE OF PIPE
PLUMBER
DESCRIPTION OF BUILDING
Industrial Commercial Residential Multiple Dwelling No. of units
6 9 A-44
Connection Charge pd
x
of Connections:
.3 el Permit Fee
D
Street Repairs
/� ' r) Street
Inspected by.
Date A!
Remarks:- -
By Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota Coy211.1 a Wit/
By
Ple notify when ready for inspection and connection and before any portion
of tha work is covered.