3221 Random Rd - Tie In Card EAGAN TOWNSHIP •
3795 Pilot ICnob Road
St. Paul, Minnesota 55111
Telephone 454 -5242
PERMIT FOR WATER SERVICE CONNECTION
Dote � .., -11 ■ 54 7
ber: L.;
Billing Neale: Cal „,„1 e ' Num
i"p` ra Sit Address
. 4,.),„1.,1 1.�,u,
fir° Billi Add r e
Plumber: -' - ,.i T
Location of Connection Meter Siz ....
,,_ Connection Chg:
r Meter No.: .). i. i i 1 `" 7 Permit Fee
f 4 -• Meter • Readi Meter Dep.
S8i Meter Sealed; Test/ Add' l Chg.
NO Total Chg.
Inspected by " V. p�
Date it-2.2.-,11
Building is a; Remarks:
R esidence _ � ....qt/ f V • � ° �" Q 32 2 `
Multiple_ "Mo. Units //
Commercial 2 --. A - - S /
Industrial_ By: • Other Chief Inspector
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
regulation. of Hagan Township, Dakota County, Minnesota.
By: .. f . ; , / (94:,,, ;s - )
Please notify the above office when ready for inspection and connection.