616 Sally Cir - Tie In Card EAGFN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Date: -. :L, ■., Number:
Billing Name: ■ Site Address: 149 y ( rd
Owner: Billing Address
Plumber:
3 too- M0
Location of Connection Meter Size Connection Chg. L/N %%72
Meter No. Permit Fee i � /�
Meter Reading Meter Dep.
Meter Sealed: Yea Add Chg.
NO Total Chg.
•
/ Inspected by
Date 0.-"pt - 7�
i
Building is a: Remarks:
Residence
Multiple No. Units _ r - f r� {
Commercial
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 Eagan Township, Dakota County, Minnesota.
By:
l
Please notify the above office when ready for inspection and connection.