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, CITY OF ORONO * z 0 1 4 - 0 0 0 7 0 * <br /> - 2750 KELLEY PARKWAY DATE ISSUED: O1/22/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2690 CAROLINE AVE <br /> PIN : 20-117-23-24-0033 <br /> LEGAL DESC : WESSELS SUBD OF SPRING PARK LO <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDEN"rIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NO"IE?: SAC GRANDFATIIERF.D IN - l3/L'#1438-O6/01/1965& HOME PRIOR <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> J.S. STEWART COMPANIES STATE SURCHARGE SEWER& WATER 5.00 <br /> 11099 LAMONT AVE <br /> HANOVER, MN 55341 MAIL-IN FEE 2.00 <br /> (763)424-9030 TOTAL 107.00 <br /> Payment(s) <br /> CHECK 5337 107.00 <br /> OWNER <br /> LIBERMAN,ZIV &TAL <br /> 1 145 SETTLERS ROAD <br /> MEDINA, MN 55340- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Building Codc. This perniit is for only the work described and does <br /> not grant permission for additional or rclated work�vhich requires separate <br /> permits. All provisions of laws and ordinances governing this rype of work <br /> shall be compicd with whether or not specitied 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 construc[ion 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[3uilding Code.This pemiit may be <br /> revoked at any time for due cause. <br /> \_Iy� yl,.� , l l <br /> npplicant Permitee Signalure Date Issucd C�y � nature Datc <br />