3905 Blackhawk Rd - Tie In Card
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MAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PMUT FOR WATER SERVICE CONNECTION
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Date: ~~/y Number: =V
Billing Name: Site Address: do
Owner: G• Billing Address
Plumbei•
Location of Connection Meter. Size Connection Cbg
Meter No. Permit Fee y•r;i
ter Reading`. Meter Dep. ter Sealed: Yes Add'1 Chg.
Total Chg.
If Inspected by
` Date
Building is a: Remarks:
Residence
Multiple- No. Unit'
Commercial
Industrial By:
Other 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 County. Minnesota.
Please notify the above office when ready for inspection and connection.