3911 Blackhawk Rd - Tie In Card EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Date: y/y/u 9 Number: 265
Billing Name: Site Address: f9 6 •6.
Owner:6.4r. 4 ( . 6. Billing Address
Plumber: /J{0,,v �c
Location of Connection Meter Size Connection Chg. Zen.00
Meter No. Permit Fee 7.5
Meter Reading Meter Dep.
Meter Sealed: Yes Add'/ Chg.
NO Total Chg.
-
Inspected by
� fir: "
iC' c * Date
Building is a: Remarks:
Residence I
Multiple No. Units
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.
By: Laite -eiX/
Please notify the above office when ready for inspection and connection.