3923 Blackhawk Rd - Tie In Card EAGAN IOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Date:
/
Billing //Name : Site Address:.57( 4 7
Owner•ai - i.' Billing Address
Plumber: J i-V //gra.
Location of Connection Meter Size Chg. 210.
7.50
Meter No.
Permit Pee
Meter Reading___ Meter Dep.
Meter Sealed: Yea Add'l Chg.
NO Total Chg.
l� t' Inspected by
spi Ivor
Building to a: Remarks:
Residence /
Multiple No. Unite
Commercial
Industrial By: 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:
Please notify the above office when ready for inspection and connection.