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� CITY OF ORONO * z 0 1 4 - 0 0 1 5 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/25/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 105 CREEK RIDGE PASS <br /> PIN : 03-117-23-12-0012 <br /> LEGAL DESC : CREEKSIDE IN ORONO <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : CONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER 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 105.00 <br /> (612)685-4303 Payment(s) <br /> Minnesota State License#: SW-1888 CHECK 25092 105.00 <br /> OWNER <br /> Hometime Video Publishing Inc <br /> 4355 PEAVEY RD <br /> CHASKA, MN 55318- <br /> AGREEMENT AND SWORN STATEMENT <br /> I�he work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City 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 goveming 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 not <br /> commenced within 180 days of the date of issuancc,or if construction is <br /> suspended for a period of 180 days at any time af[er work has commenced. <br /> The applicant is responsible for assuring all required inspec[ions are <br /> requested in conformance with[he State Building Code.This permit may be <br /> revoked at any[ime for due cause. <br /> il —__ <br /> � / / <br /> Applicant Permitee Signaturc Date [ssucd By Si ture DaCe <br />