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CITY OF ORONO * Z 0 1 7 — 0 0 5 4 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/22/2017 <br /> � ORONO, MN 55356- <br /> s (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2090 SHORELINE DR <br /> PIK : 15-117-23-23-0001 <br /> LEGAL DESC : CINPLATTED 15 I 17 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: DISCONNECT ONLY FOR SECONDARY HOUSE(SUMMER HOUSE) <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> TOTAL 51.00 <br /> G.S. Meichels Payment(s) <br /> 4715 13th Ave So. cRE�tT caxD s2s2 s�.00 <br /> Minneapolis, MN 55407 <br /> OWNER <br /> HEAD, MARTHA <br /> 1616 W.22ND STREET <br /> MINNEAPOLIS, MN 55405- <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 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 i conformance with the State Building Code.This permit may be „ <br /> revoke any time for due ause. _ , /(y� <br /> � /� l <br /> � �-����� /t�c,�? %`..�_�: �f��J c;, �� i <br /> Applicant Permitee Signature Date Issued By Signature Date <br />