4031 Pumice Lane - Tie In Card `4'` EAGAN TOWNSHIP
3795 Pilot Knob Road
St. u1, -m7
TePale -524 55111 2..1
PERMIT FOR WATER SERVICE CONNECTION
Date: f f''I 1 7 Number: 877 \
Billing Name Q C C ( .•('),4 \.,1: � Site Addreae:). -/n y j 0(.1_ ) IN l Cs p ,At(,
owner: C :. i �.!`\4.•P t i \ . Billing Address / ,'` - i.) ( l'A'\c`, . 14
Pl Q.1 , t' X t l I') l" "t A. � � � : �() Cj ���
Location of Connection Meter Size Connection Chg. 300.00 ri 7/
Meter No. Permit Fee 10.00 ni 7f
Meter Readia Meter Dep. .S° d 7/3
,
Meter Sealed: Yes_ Add'l Chg.
5 _� NO Total Chg.
Inspected by
Date 7-71- 7 't/
Building is'a; Remarks:
Residence x
Multiple .No. Multiple ,
a . . Commercial
Industrial By: •
Other Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do tle proposed work, in accordance with the rules and
regulations of Sagan Township, Dakota County, MinTsota.
Please notify the above office when ready for inspection and connection.