3955 Palisade Way - Tie In Card EAGAN TOWNSHIP
' 3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 4545242
k +' T FOR WATER SERVICE CONNECTION
Date: f� Number: 11(ur
f�
Billing
Name. 4 Fite Address 1
OwAe 10:e Billing Address � 1")r/` (4=/
Plumber: t 1
Location of Connection Meter Size Connection Chg. ,a 12/29/t2
Meter No. � Permit Fee 1fl.ro r^d 12/29/72
• Meter Reads Meter Dep. '50 pd 12/29'
Meter Sealed: Yea Add'l Chg.
� Total' -Chg.
Inspected by
Date Vi/75
Building La a: Remarks:
Residence '
Multiple` • No. Units
Commercial
Industrial By:
Other Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do tile proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minneao
(N ivy k ;r.
Pleaao notify the sbove office when ready for inspection end connection.