4100 Skylark Lane - Tie In Card .,.„ EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Date: h 441 7 12, 1972 Number: 693
Billing Name: oe- f1'7'recuiala aii S Site Addrese:li100 -Or -t. , 14 -o6 ri -i1 7: - 71, -tr; -id
:ityl.ark I,..;,,,4
Owner: '' 640 Billing Address
Plumber' Welarke Tr+&nohing & Exorvating
Location of Connection Meter Size Connection Chg. 1 Y
r. Meter No. r " i - i 9 i 0 , Permit Fee ),,
Meter Reading Meter Dep.2 p
r
9
'./ Meter Sealed: Yes Add'l Chg.
• 4 A NO Total Chg. i to
r, r
‘1,111 40 �0 1 Inspected by
Date
Building is a: Remarks:
Residence , I,� 14') [E 10'1
Multiple x No. Unitml° ' ° ` ri ' 14° ' `'Jh1P;OPEEI11 dliIALLEO (,1ETERS.
Commercial
Industrial By:
Other Chief Inspector
In consideration of the issue And delivery tome of the above permit, I
hereby agree to do the proposed work in accordance with, the rules and
regulations of Hagan Township. Dakota County, Minnesota:
By:
∎arterice.,Treaahir & L:s:aavatiug
Please notify the above office when ready for inspection and connection.
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