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CITY OF ORONO * z 0 1 6 - 0 1 5 0 9 * <br /> r . " 2750 KELLEY PARKWAY DATE ISSUED: 12/OU2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2800 SHADYWOOD RD <br /> P[N : 21-117-23-13-0023 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1196 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOI�T TYPE : DISCONNECTION <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> WATERCONNECT/DISCONNECT/REPAIR 50.00 <br /> HAVEL EXCAVATING STATE SURCHARGE SEWER&WATER 1.00 <br /> 10415 CAIN RD <br /> ROGERS, MN 55374- TOTAL 101.00 <br /> (612)363-4533 Payment(s) <br /> CHECK 4529 101.00 <br /> OWNER <br /> BERGH, HANS& SHARON <br /> 2800 SHADYWOOD RD <br /> EXCELSIOR, MN 55331- <br /> AGREEMENT AIYD 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 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 construction is <br /> suspended for a period of 180 days at any time afrer 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 /> revoked at any time for due cause. <br /> i <br /> / <br /> �—'S� <br /> � j-��_��., I� � �� C� <br /> pplic t Pe itee ignature Date Issued By Sig ture Date <br />