3929 Blackhawk Rd - Tie In Card
s
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: J/1 A Number
Billing No : Site Address: S(~ ~-h S9,~9
Owner: ,yfl ,moo Billing Address
Plumber:
location of Connection Meter Size Connection Chg.
Meter No. Permit Feed
Meter Reading- Meter Dep.
Meter Sealed: Yes Add'1 Chg.
NO Total Chg. e ~ Inspected by
Dace
Bu lding is a: Remarks:
Residence_ -
Multiple No. Units
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, nnesota.
By: -rfl
Please notify the above office when ready for inspection and connection.