3936 Blackhawk Cir - Tie In Card EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Date / -J'+ (1?1!9/721
Number: 11°6
5'
Billing Name : {" 1-'T• Cu.1 truB+.ian Site Address.'' - 1l`o T 1 ?
Owner: ",LL, Billing Address
Plumber: Lain'
Connection Chgt
Meter Size '! �' ` . LI ' 'x/20/73
Location of Connection - ---- --
Meter No. Permit Pee /72
{(
air
Meter Reading` Meter Dep.
io1 Meter Sealed: Yes_ Add'l Chg.
iD NO Total Cb
Inspected by
Building is a: Remarks:
Residence '
$25.00 REINSPECTION FEE FOR
Multiple No unita IMPROPERLY INSTALLED METERS.
Commercial
Industrial B y ° Chief Inspector
Other
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do tte proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota.
By:
Please notify the above office when ready for inspection and connection.