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CITY OF ORONO * Z 0 1 2 - 0 0 9 4 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/19/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1370 CHERRY PL <br /> PIN : 08-117-23-32-0022 <br /> LEGAL DESC : SAGA HILL REVISED <br /> : LOT 000 BLOCK 011 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWFR DISCONNECT <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BURNS EXCAVATING, INC. STATE SURCHARGE SEWER&WATER 5.00 <br /> 3470 CO. RD 21 <br /> MAYER, MN 55360- TOTAL 55.00 <br /> (612)685-4303 <br /> Minnesota State License#: 1888 <br /> OWNER <br /> NAFSTAD, ER[K <br /> 1370 CHERRY PL <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for N�hich 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 permit is for only the work described and does <br /> not grant permission for additiona]or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming 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 applicant is responsible for assuring alI required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> 'i 9 ' � � 9, i y ,��- <br /> Applicant Permitee Signature ' Date Issue By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />