4104 Skylark Lane - Tie In Card EAGAN Ta1NSHIP
3795 Pilot Knob Road
St. PaulTelep hoaep454- 52425111
PERMIT FOR WATER SERVICE CONNECTION
, may 1 2, 19 Number: 81.3
Date; 1GU G$- t {1_G, -txi ; 1 " -1L -tU -113
Billing Name:1 Hldp. 5 Site Address: a,y
Owner:
rr Billing Address
Plumber:
Veierke 7xenobing 4 1xouwating
Meter Size,�,�„�.___r Connection Chg .____,.....i..-1/
Location of Connection _ ,
o .} 7 ' d �J$ Permit Fee 10 ;7
Meter No ._. r ._� -- ,
r ter Dep.' >'
Meter Reading — Me I
�, Meter Sealed: Yes_ Add' 1 Chg.,,,,,T_.—,- - ,
ANO_____, Total Chg.____- -- .. -- - -
.�� tko 1 Inspected by
Date
Building 1.a a:
Remarks:
Residence $2,) U.; 1 „ a LP., IlUt1 [ EZ. I Oil
Multiple �
No. Dnits y °61111(3 `.1h1PROPLtL l ,IVJi \LLEO LILTEIiS.
Commercial
Industrial._ B y' 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:
tints kd b cuzghiu " vutlug
Please notify the above office when ready for inspection and connection.