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CITY OF ORONO PERMIT NO.: 2009-00154 <br /> . 2750 KELLEY PARKWAY <br /> � ORONO, MN 55356- DATE ISSUED: 04/14/2009 <br /> ' ` 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2680 SHADYWOOD RD <br /> PIN : 21-117-23-24-0046 <br /> LEGAL DESC : SHORE HILLS <br /> : LOT O15 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER PIPE 4" <br /> WATER PIPE 7"POLY W/V�'IRE <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER&WATER WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 6501 CO. RD 15 <br /> MOUND,MN 55364 STATE SURCHARGE SEWER&WATER 0.50 <br /> (952)472-4959 S.A.C. 0.00 <br /> Minnesota State License#: 1804PM TOTAL 100.50 <br /> OWNER <br /> SEWALL,BARRY <br /> 2680 SHADYWOOD RD <br /> EXCELSIOR,MN 55331- <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 sepazate <br /> permits. All provisions of laws 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 construction authorized is not <br /> commenced within 180 days of the date of issuance,or if consWction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is responsibl for suring all required inspections aze <br /> requested in conform e State Building Code.This permit may be <br /> revoked a ' e r e <br /> � / / / / <br /> pp ' ant Permitee Signature ate Issued By � ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED VE. <br />