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4 , <br /> CITY OF ORONO * Z pJ 1 3 - 0 0 9 1 5 * � <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/06/2013 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: 952) 249-4616 <br /> ADDRESS : 1910 SHORELINE DR <br /> PIN : 10-117-23-42-0017 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0096 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER CONNECTION-4"PIPE SIZE-SCHEDULE 40 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER&WATER STATE SURCHARGE SEWER&WATER 5.00 <br /> 6501 CO.RD 15 <br /> MOLJND, MN 55364 MAIL-IN FEE 2.00 <br /> (952)472-4959 TOTAL 57.00 <br /> Minnesota State License#: 1804 PAID WITH CC# 7464 <br /> OWNER <br /> &H MOUSAVINASAB,MAJID FEHRESTI <br /> 1910 SHORELINE DR <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 sepazate <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 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 /> revok t any time for due cau e. <br /> � 9� � � �3 � �}, � , 1 <br /> Applicant Permitee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />