4355 Lodgepole Dr - Tie In Card EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
ts59
Ju h hy7o Number:
Date: 1t3.`i5 LcdEi(: Liiv
Billing Name:T �p11stxvotion ■Co. Site Address:
Billing Address
Owner:
Plumber:
Meter Size Chg.? � / /(`
Location of Conne• ion � � r /its /'
Meter No. Permit Feed t2
Meter Reading_____. Meter
Meter Sealed: Sealed: Yes Add'l
-5 a Total
Inspected by
Building
is a: Remarks:
Residence roc , •15 0Q RE-INSPECTION FEE FOR
Multiple _ No. unite „ '!!STALLED METERS.
Commercial
Industrial B y : Chief Inspector
tip!„ 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 Eagan Township, Dakota County,
By: j " i ✓i /i
Please notify the above office when ready for inspection and connection.