3733 Blackhawk Rd - Tie In Card EACAN TOWNSHIP
3795 Pilot bt Road
111
St. Paul,
Telephone 454 -5242
PEST FOR WATER SERVICE CONNECTION
_ Number:
rd
Date ectot r 3� li Jd d
Billing Name.' - rr Lt
tsr:. Site Address 3
Owner: .:rr - j "ros .
Billing Address
Plumber ai i lw:t;iu:' e 4iu .
Meter Size Connection Chg.�—
Location of Connection
` o ;; StttiT OF Meter No.
Permit Fee s=:..-- -
r.r VLA Itt - ,Ci tuJ AS coati :crio Meter Reading Meter
FLl IS tii Ya'.I�.
Meter Sealed: Yes__ Add'1
7
_ Total
O
3 ? — 3 2 Inspected by
Date
Building is a:
Remarks:
Residence "N 525.00 REtNSP FEE FOR
Multiple _ No. units IMpROPERIY INST 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 the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota.
By:
1Y
Please notify the above office when ready for inspection and connection.