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CITY OF ORONO PERMIT NO.: 2009-00�9� <br /> " � 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssvEn: 04/30/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2623 CASCO POINT RD <br /> PIN : 20-117-23-24-0032 <br /> LEGAL DESC : SPRING PARK <br /> : LOT 141 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC PD WITH BUILDING PERMIT <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> KEVITT EXC. INC. WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 3335 PENNSYLVANIA AVE NO <br /> CRYSTAL, MN 55427 STATE SURCHARGE SEWER&WATER 0.50 <br /> (763)545-3557 TOTAL 100.50 <br /> OWNER <br /> KUBALAK,THOMAS&PATRICIA <br /> 2623 CASCO POINT 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,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 no[ <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 t any time for due cause. <br /> ,v.� y , ,�� � 09 <br /> � � <br /> Applicant Permitee Signature Date Issued B ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB VE. <br />