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� ' CITY OF ORONO * z 0 1 2 — 0 1 2 5 3 * <br /> 2750 KELLEY PARKWAY �ATE [ssuE�: 12/18/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 80 CREEK RIDGE PASS <br /> PIN : 03-117-23-12-0018 <br /> LEGAL DESC : CREEKSIDE IN ORONO <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTG: SEWER CONNECTION FROM STREGT"I�O HOUSE-4" PIPG-SCHD 40 <br /> WATER CONNF,CTION FROM STREGT TO HOUSE- 1" PIP� <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> NEUTGENS EXCAVATING&CONSTRUCTION WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 16230 54TH ST <br /> ST MICHAEL, MN 55376- STATE SURCHARGE SEWER& WATER 5.00 <br /> (612)282-5563 TOTAL 105.00 <br /> OWNER <br /> Hometime Video Publishing Inc <br /> 4355 PEAVY RD <br /> CHASKA, MN 55318- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc wor�;ibr which this permit is issucd shall be perfornicd according to <br /> the approvcd plans and specifications,applicable Ciry approvals,and thc <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 whethcr or not specified hercin."I'his 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 I 80 days at any time aCter work has commenced. <br /> I�he applicant is responsible for assuring all required inspections are <br /> requcsted in conformance with the State[3uilding Code.This permit may bc <br /> revoked at any time r due cause. <br /> � � � /z� ��� �z- <br /> Applicant Permitce, ignatur Datc I . ed By Signature Datc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />