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� <br /> r <br /> CITY OF ORONO PERM[T NO.: 2011-01434 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE [SSUEn: 1U14/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3095 CASCO POINT RD <br /> PIN : 20-117-23-34-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1311 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER CONNECTION-4"PIPE SIZE <br /> WATER CONNECTION- 1"PIPE SIZE <br /> APPLICANT $EWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> FINAL GRADE, INC WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 3441 BLUFF DR. <br /> JORDAN, MN 55352 STATE SURCHARGE SEWER& WATER 5.00 <br /> (952)492-5100 TOTAL 105.00 <br /> Minnesota State License#: 1442 PAID WITH CC# 5018 <br /> OWNER <br /> WHIPPLE, PHILLIP <br /> 3095 CASCO PT 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. 1'his permit is for only the work described and does <br /> not grant pennission for additional or related work which requires separate <br /> permits. All provisions o1�laws and ordinances governing this type of work <br /> shall be compied with whether or no[specified herein.This permit will <br /> expire and become null and void if construction au[horized 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 Buiiding Code.This permit may be <br /> revoked at any time for due cause. <br /> Applicant Permitee Signature /Date / � � // � / � � <br /> Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />