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- CITY OF ORONO PERMIT NO.: 2011-01489 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 1 U30/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1404 BALDUR PARK RD <br /> PIN : 08-117-23-34-0018 <br /> LEGAL DESC : BALDUR PARK <br /> : LOT 014 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCT[ON TYPE : CONNECTION <br /> NOTE: NEW SEWF,R CONNECTINO-4"PIPE-SCHEDULE 40 <br /> APPLICANT <br /> SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER& WATER <br /> 6501 CO. RD 15 STATE SURCHARGE SEWER& WATER 5.00 <br /> MOUND, MN 55364 TOTAL 55.00 <br /> (952)472-4959 <br /> Minnesota State License#: 1804 <br /> OWNER <br /> MILBRATH, BENJAMIN <br /> 1404 BALDUR PARK 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,app]icable 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 sepazate <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 I 80 days of the date of issuance,or if construc[ion is <br /> suspended for a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible for uring all required inspections are <br /> requested in conforman i t State Building Code.This permit may be <br /> revo �me u se. <br /> '� � l � �( l/ l��/ � <br /> Ap icant Permitee Signature Date Issue By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />