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CITY OF ORONO PERMIT NO.: 2011-00162 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 03/17/2011 <br /> • <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2605 WEST LAFAYETTE RD <br /> PIN : 21-117-23-21-0007 <br /> LEGAL DESC : SHORE HILLS <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: WATER CONNECTION <br /> APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER& WATER STATE SURCHARGE SEWER&WATER 5.00 <br /> 6501 CO.RD 15 <br /> MOUND,MN 55364 TOTAL 55.00 <br /> (952)472-4959 <br /> Minnesota State License#: 1804 <br /> , / /,04COWNER ,C?G? <br /> BLANKENSHIP,BRADFORD&DEBORAH <br /> 2605 WEST LAFAYETTE RD 7/. a Sao . 0 O <br /> EXCELSIOR,MN 55331- <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 any t.• •r due cause. <br /> -'� //7/ 7 / <br /> plicant •ermitee Sig :I re Date Issue.<:y Signature Date / <br /> /SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBE dIABOVE. <br />