4055 Blackhawk Rd - Tie In Card
MAN TOWNSHIP sJ~""'r
3795 Pilot Knob Road ~A►
St, Paul, Minnesota 55111 `
~sr' 4 Tolepbone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date:_ L ?s. 197(-) Number: r
Billing Name: C nr car ~ ~,,,;>t r~ Site
Ad reas• 4055 hl
Owner: r.:ua Billing Address 73->3
Plumber: aai,; s~~i;. c• ,,,,t
t ire.
>G7y
Location of Connection Meter Size -
Connection Chg... ~ "(l(7tJ
r
9
`3 Meter No.
~ Permit Fee
Meter Reading Meter Dep.
(yq Meter Sealed: Yea AddOl Chg,
7 s/ _ NO Total chg.
Inspected by
Date 9-/- 7a
Building is a: Remarks:
Residence
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
i regulations of Eagan Township, Dakota County, Minnesota.
By: C iar lieov, i:ugEi L"CUCL itil1 (i
I
Please notify the above office when ready for inspection and connection.
I