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� � CITY OF ORONO <br /> � 2750 KELLEY PARKWAY * � 0 1 7 - 0 0 1 4 PJ * <br /> DATE ISSUED: 02/14/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2800 SHADYWOOD RD <br /> PIN : 21-117-23-13-0023 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1196 <br /> : LOT 000 BLOCK 000 <br /> PERM[T TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER AND WATER CONNECTION <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> SCHERBERCOMPANY, LLC WATERCONNECT/DISCONNECT/REPA[R 50.00 <br /> 20160 75TH LANE N STATE SURCHARGE SEWER&WATER 1.00 <br /> CORCORAN,MN 55340- TOTAL 101.00 <br /> (763)497-1100 Payment(s) <br /> CHECK 17832 101.00 <br /> OWIVER <br /> BERGH, HANS&SHARON <br /> 2800 SHADYWOOD RD <br /> EXCELSIOR, MN 55331- <br /> AGREEMENT AND SWORN STATEMENT <br /> "1'he 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 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 l80 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 conformance with the State Building Code.This permit may be <br /> revoke at any time for due cause. <br /> � C.v� �" �l', � - �(� ��� l o� i / i/ <br /> Applicant Permi e �gnature Date Issued By i nature Date <br />