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y CITY OF ORONO <br /> * 2012 - 00304 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/19/2012 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 3645 TOGO RD <br /> PIN 17-117-23-31-0034 <br /> LEGAL DESC TOWNSITE OF LANGDON PARK <br /> LOT 006 BLOCK 010 <br /> PERMIT TYPE SEWER&WATER <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE CONNECTION <br /> NOTE: WATER&SEWER CONNECTION <br /> SEWER PIPE SIZE-4" PVC <br /> WATER PIPE SIZE- V PVC <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> GROTH SEWER&WATER WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 775 TOWER DRIVE <br /> HAMEL,MN 55340- STATE SURCHARGE SEWER&WATER 5.00 <br /> (763)478-6712 TOTAL 105.00 <br /> Minnesota State License#:058606-PM <br /> OWNER <br /> ZHUK,ELENA <br /> 3645 TOGO RD <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 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 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 /> revoked at anime for due cause. <br /> � / fl- / /2 '�4, � / ' <br /> ' - <br /> Ap t tee S nature Date Is By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />