3935 Blackhawk Rd - Tie In Card
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: Number: 239
Billing Name. q ~y site Address: jS 4 •6 . 935
Owners e ~y.cp Billing Address
Plumber:
Location of Connection Meter Size Connection Chg. 2oo_n0
Meter No. Permit Fee 7 3(L-
Meter Reading Meter Dep.
Meter Sealed: Yes- Addll Chg.
NO Total Chg.
f'
Q r Inspected by
Date
Building 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 Coun , Minnesota.
94 -
By: 6,44
4
Please notify the above office when ready for inspection and connection.