3741 Blackhawk Rd - Tie In Card
ftGA.N •.1HSHIP
3795 Pilot Knob Road
-St. Paul. Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: Oct. 13, 1969 Number:)
Billing Name: 1,.al Severe- Site Address: ;'741 ulacbfiaw', lizi.
Owner: Billing Address
Plumber- '4enzal FlbE-. ,c htg.
Location of Connection Meter Size Connection Chg." ,00 r;i. 10/13
`,l , -J c Hsu s5~ Meter No, Permit Fee '7.50 t'd. 10/20
Meter Readings- Meter Dep. 15.00 iu. 10/13
Meter Sealed: Yea Add'l Chg.
NO Total Chg. co_
I
L.,
Inspected by,
Date Z.t
Building is a: Remarks:±
Residence X
Multiple No. Units
Commercial
Industrial ✓✓By: rrrttt 8
Other Chief I pectr-
w-
In consideration of the issue and delivery to me of the above pe t, I
hereby agree to do the proposed work in accordance with the rules nd
regulations of Eagan Township, Dakota County, Minnesota.
By: Wenzel i lbg. i htl-
Please notify the above office when ready for inspection and connection.