1420 Highview Ave - Tie In Card EACFN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242 '
PERMIT FOR WATER SERVICE CONNECTION
Date: Anrnet ?5. 1'71 Number: (')4
Billing Name:
Bernard A. Poulson Site Address: 1420 014:Wien Fv ..u::, C,.gau 5512i
Owner: male Billing Address
Plumber: r. - .•'••l l r - :nrr ri
Location of Connection Meter Size- = Connection Chg. _.iii, r.d 6/25/7 .�
{.� .O. ..o.. -"xi', -,
� ._
V L Meter N 4 ' 7 Permit Fee
Meter Reading„ Meter Dep. 15.00 pd 6/25/71
, ( Thi Meter Sealed: Yes Add' 1 Chg. . ' " - -r / •
;v. NO Total Chg.
Sle
% 1 Inspected by
6py LI E Date /D -1 y 111 7 I
Building is a: 1 Remarks:
Residence XXICK
Multiple No. Unita • ,0:•. ,IIJii fEE FOR
Commercial $25.03 h"--."". "D
DtPRDPERIA IHS P,tETERS,
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 Sagan Township, Dakota County, Minnesota.
,; _ y �
By: K,:. - , . - ' i.:,.. -
Please notify the above office when ready for inspection and connection.