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, <br /> CITY OF ORONO * Z 0 1 6 - PJ 0 4 7 9 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/OS/2016 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1416 BALDUR PARK RD <br /> PIN : 08-117-23-34-0015 <br /> LEGAL DESC : BALDUR PARK <br /> : LOT O11 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR ONLY <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> ROTO ROOTER SERVICES CO. TOTAL 51.00 <br /> 14530 27TH AVE.N. Payment(s) <br /> MINNEAPOLIS,MN 55447- 51.00 <br /> (763)519-3907 <br /> OWNER <br /> MARCIA PETERSON,JEFFREY ULKU/ <br /> 1416 BALDUR PARK RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <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 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 l SO 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 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 /> � . <br /> � _ . � ' �-_ � t- _ . �-v �1 I���v S , S � I� <br /> ppl�cant Permitee �gnature ate Issued By Signature Date <br />