3917 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-/'1V/ q Number: 264
Billing Name: Site Address: .5"7 G 3~/7 f
Owner: k, 4. 11-- (J>W- _it Billing Address
Plumber:- J&I al~ .
Location of Connection Meter Size Connection Chg. 30.00-
Meter No, Permit Fee
Meter Reading L__ Meter Dep.
Meter Sealed: Yes_ Add'1 Chg.
NO Total Chg.
Inspected by
-
Dace
Building is a: Remarks:
Residence-)_
Multiple No. Units
Coamercial
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:
Please notify the above office when ready for inspection and connection.