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City of Lakeviile
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Sew►er and f�Vater Tie Card
'` Address_ ����(.� �l l'1 i�'L.��/1/In�U� �/��
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Contractor
Permit Number_ ( � � � ��
' Date
Street Drain-tile
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Size of Water Service
Comments � jZTE I"1��(�. ��/�{2 �� 2 ��-rr+ivG�S
�e�s� have fhi� c��c� or� s�fe for �he inspector at the fim�
of the ir�sp�ectc�n. '
20195 Holyoke Avenue,Lakeville,MN 55044
952-985-4400•952-985-4499 fax
www.lakevillemn.gov