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CITY OF ORONO PERMIT NO.: 2009-00326 <br /> � h 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 06/17/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2100 SHADYWOOD RD <br /> PIN : 17-117-23-31-0041 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 030 BLOCK 001 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: <br /> WATER AND SEWER DISCONNECT. <br /> APPLICANT <br /> SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER& WATER WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 650]CO.RD 15 <br /> MOUND, MN 55364 STATE SURCHARGE SEWER&WATER 0.50 <br /> (952)472-4959 TOTAL 100.50 <br /> Minnesota State License#: 58019PM <br /> OWNER <br /> MARHULA, DAREN <br /> 2100 SHADYWOOD RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied wi[h whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conf ance with e Building Code.This permit may be <br /> revoked at any ti for dge'$ se ; <br /> '" '� � / (-7 / o� <br /> i iQ <br /> Applicant ermitee Signature Date Iss e By ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />