4060 Halite Lane - Tie In Card EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: ( i -- '') Number:
Billing Name: "'• Site Address:
e , ,
Omer: , e •\ ‘ Billing Address 1
Plumber:
)
Location of Connection Meter Size Connection Chg.
V ---1
Meter No. Permit Fee I - e ee i 't.
) ,6 Meter Reading Meter Dep.
I r 23 Meter Sealed: Yes Add'l Chg.
NO Total Chg.
Inspected by
Date 7- 7— .7 Z---
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 de proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota.
By:" el , 1 “ *"`",,'
Please notify the above office when ready for inspection and connection.