4074 Limonite Lane - Tie In Card EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Number:
Date: ,
Billing Name•
n Site Address•
Billing Addreea i ` r
Owner:
Plumber:
Location of Connection Meter Size
Connection Chg.
Meter No. Permit
Meter Reading Meter Dep.
Meter Sealed: Ye Add'l Chg•
Total Chg.
it
�0 � ." Inspected by
Date ld — 7 •�__/
Building is a: Remarks:
Residence
Multiple No. Units
Commercial
Industrial Hy' 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: s.
Please notify the above office when ready for inspection and connection.