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• CITY OF ORONO * 2 0 1 4 - 0 1 4 3 9 <br /> • 2750 KELLEY PARKWAY DATE ISSUED: 01/08/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 825 WILLOW DR S <br /> PIN 10-117-23-22-0001 <br /> LEGAL DESC UNPLATTED 10 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE SEWER <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE DISCONNECTION <br /> NOTE: SEWER DISCONNECT ONLY <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 5.00 <br /> GROTH SEWER&WATER TOTAL 55.00 <br /> 775 TOWER DRIVE Payment(s) <br /> HAMEL,MN 55340- CHECK 6912 55.00 <br /> (763)478-6712 <br /> OWNER <br /> BRUNELLO,JOHN <br /> 825 WILLOW DR S <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 any time for due cause. p <br /> �-V7�C"V7 U <br /> Applicant Permitee Signature Date Issued B ignature Date <br />