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CITY OF ORONO PERMIT NO.: 2011-00439 <br /> -. 2750 KELLEY PARKWAY <br /> ' ORONO, MN 5535G- DATE ISSUED: 06/08/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 115 CREEK RIDGE PASS <br /> PIN : 03-117-23-12-0013 <br /> LEGAL DESC : CREEKSIDE IN ORONO <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTIOI�I TYPE : CONNECTION <br /> NOTE: SAC PA[D W[TH BUILDING YERMIT 20 1 1-003 1 8 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BURNS EXCAVAT[NG, INC. <br /> 3470 CO. RD 21 WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> MAYER, MN 55360- STATE SURCHARGE SEWER&WATER 5.00 <br /> (612)685-4303 MAIL-IN FEE 2.00 <br /> Minnesota State License#: 1888 TOTAL 107.00 <br /> OWNER <br /> PFEIFER,ANDY&MARNIE <br /> 115 CREEK RIDGE PASS <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMEIYT <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. 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 whether or no[speciYied herein.This permit will <br /> �expire and become null and void if construction au[horized is not <br /> commenced wi[hin 180 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 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 Building Code.This permit may be <br /> revoked at any time for due cause. <br /> l_`��`�"'�,,,�(, ", � � � / / <br /> Applicant Permitee Signature Date Issued y S� ature at <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED A O <br />