1871 Carnelian Lane - Tie In Card
ULAN TOWNSHIP t-1~1
3795 pilot Knob Road
St. Paul. Minnesota 55111
Telephone 454-5242
pgEKIT FOR WATER SERVICE COMECTIOti
Number: 3,16
Date. (G'' r~ r,'/
dress:
~ ~ ite Ad
Y\ S
M!~
Billing Name
Billing Address '
owner: 4 `~•j i.v , r'
Plumber: `
;
Meter , i~ ~a 7/3/7
Size-,- Connection Cbg.---~
Location of Connection Permit Fee 1U U3 +/~/(2
Mater
Meter Reading,~ Meter Dep.
~a
Add '
Meter Sealed: Yeas 1 Chg•-,.~...-----"~
Total Cbg•!
N0
i
3s Inspected by
q Date
~•~ff Remarks:
Building is a:
xi:
Residence
Multiple _ No. Units
Cosmercial
By: Chief Inspector
Industrial-
Other
of the above permit, I
In consideration of the issue and delivery or me
agree to do tte proposed work in accordance with the rules and +
hereby Rage Township, Dakota County. Mine
regulations of Rags
t , + "k BY:
Please notify the above office when ready for inspection and connection.