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* "' CITY OF ORONO * 2 0 1 4 — 0 0 3 3 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUEll: 04/18/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2627 CASCADE LA <br /> PIN : 33-118-23-I1-0115 <br /> LEGAL DESC : STONEBAY FIFTH ADDITION <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCT[ON TYPE : CONNECTION <br /> NOTf;: WATER& SEW�R CONNF,CTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> T& J CONCRETE STATE SURCHARGE SEWER& WATER 5.00 <br /> 9100 BALTIMORE STREET NE <br /> BLAINE, MN 55449- TOTAL 105.00 <br /> (763)413-0988 Payment(s) <br /> Minnesota State License#: SW-646112 CHECK 12865 105.00 <br /> OWNER <br /> BU[LDERS LLC, STONEBAY <br /> 14870 BROCKTON LANE <br /> DAYTON, MN 55327- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be periormed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State[3uilding Code. '�his perniit 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 goveming this type of work <br /> shall be compied wi[h 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 ofthe date of issuance,or if constr��ction 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 cunformance with the State E3uilding Code.This permit may be <br /> revoked at anv time for due cause. <br /> � ����`�� , �,/ <br /> � <br /> Applicant Permitee Signature Date � Issu By Signature Date <br />