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r <br /> , CITY OF ORONO * z 0 1 z — B 0 7 6 0 * <br /> ' , 2750 KELLEY PARKWAY DATE ISSUED: 08/06/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 325 CRESTVIEW AVE <br /> PIN : OS-117-23-14-0031 <br /> LEGAL DESC : BAYSIDE ADDN TO LAKE MINNETONK <br /> : LOT 000 BLOCK 005 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : D[SCONNECTION <br /> APPL[CANT SEWER CONNECT/D[SCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 <br /> 6501 CO. RD 15 <br /> MOUND, MN 55364 - -��"' <br /> �9s2�4�2-4as9 TOTaL s�.00 <br /> Minnesota State License#: 1804 <br /> OWNER <br /> SULLIVAN, WENDY <br /> 3409 26TH.AVE. S <br /> M[NNEAPOLIS, MN 55406- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,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 not specitied herein.This pennit 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 all required inspections are <br /> requested in conformance wi[h the State Building Code.This permit may be <br /> revoked aY any time�� �� <br /> ..-- ,� - , ,% <br /> �--_....�_.� / - / �.� (.C/t't--�' / / <br /> pplicant Permitee Signature Date lssucd I3y � nature Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER HAN DESCR[BED AB . <br />