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i . � <br /> CITY OF ORONO PERMIT NO.: 2009-00643 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUEn: 09/29/2009 <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 : CONNECTION <br /> NOTE: <br /> WATER AND SEWER CONNECTION-PIPE SIZE-4 INCHES,MATERIAL-PVC SCHED 40 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> UP NORTH MECHANICAL WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 43900 ELMCREST AVE <br /> P.O.BOX 35 STATE SURCHARGE SEWER&WATER 0.50 <br /> HARRIS,MN 55032 TOTAL 100.50 <br /> (651)277-0515 <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 Iaws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if wnstruction 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 quired inspections aze <br /> reque confo ith e S uilding Code.This permit ay be <br /> rev ed any � e for , ise <br /> _ / / // � <br /> A ermitee Signature Date d By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />