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CITY OF ORONO PERMIT NO.: 2011-00696 <br /> 2750 KELLEY PARKWAY '�� � y <br /> r ORONO, MN 55356- DATE Iss[1En: 07/2U2011 <br /> � 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2905 SIXTH AVE N <br /> PIN : 28-118-23-31-0006 <br /> LEGAL DESC : GARDEN GROVE <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> � <br /> NOTE: PD$]2,530.00 CK ]3284 FOR ASSESSMENT s� !`.�,L, � <br /> �� <br /> ! <br /> G� <br /> �� ��% <br /> ��. � <br /> � ° t`� <br /> � r�,,. <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WRUCK EXCAVATING, INC. STATE SURCHARGE SEWER& WATER 0.50 <br /> 15096 102ND ST <br /> BECKER,MN 55308 S.A.C. 0.00 <br /> (320)267-1855 TOTAL 50.50 <br /> Minnesota State License#: 2714 <br /> OWNER <br /> HAGEN&AGNETA TOTH,JEFFREY <br /> 2905 SIXTH AVE N <br /> LONG LAKE,MN 55356- <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 /> perniits. 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 wnformance with the State Building Code.This permit may be <br /> revv4ccd-ats�ay.pme for due cause. <br /> � � �� � � � j � ���'►�t� l l <br /> Applicant Permitee Signature Date Issued B gnature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />