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, CITY OF ORONO * z a 1 3 — PJ PJ 9 1 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/06/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3884 CHERRY AVE <br /> PIN : 08-117-23-33-0084 <br /> LEGAL DESC : CRYSTAL BAY VIEW <br /> : LOT 000 BLOCK 003 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NO"I�l?: SAC 5/6/70#2413 <br /> APPLICANT SEWER CONNECT/DISCONNECT/IZEPAIR 50.00 <br /> GILES BROTHERS EXCAVATING INC STATE SURCHARGE SEWER& WATER 5.00 <br /> 4114 JUDY CT <br /> NEW MARKET, MN 55054- TOTAL 55.00 <br /> (612)366-4995 PAID WITH CC# 2625 <br /> Minnesota State License#: 11 19 <br /> OWNER <br /> ENGLUND, DOUGLAS <br /> 3884 CHERRY AVE <br /> P.O. BOX 285 <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> I'hc work lor which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Building Code. This 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 of laws and ordinances governing this type of work <br /> shall be compied 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 construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applican is responsible for assuring all required inspections are <br /> requested in onformance with the State Building Code.This permit may be <br /> revoked at an time for due cause. l <br /> p �/ f� <br /> / �c.-C.-^'" -�� Z-� / / � / � � � / / <br /> A plicant Permitee Signarure _ Date Issued y Si ture Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOV <br />