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�ti <br /> ` CITY OF ORONO * Z 0 1 4 — 0 1 0 8 5 * <br /> 27_50 KELLEY PARKWAY DATE ISSUED: 09/23/2014 <br /> ORONO, MN 55356- <br /> (9�2) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3309 CRYSTAL BAY RD <br /> PIN ; 17-117-23-41-0016 <br /> LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B <br /> : LOT 001 BLOCK 000 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWI;R& w'ATGR DISCONNECT <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> D.S.M. EXCAVATING STATE SURCHARGE SEWER&WATER 5.00 <br /> 2916 ENTERPRISE AVE <br /> HASTINGS. MN 55033- TOTAL 105.00 <br /> (651)480-1355 Payment(s) <br /> CREDIT CARD 0444 105.00 <br /> OWNER <br /> SCHMID, DAVID <br /> 3309 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMF,NT <br /> The work for which this pennit 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 granf permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governin�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 /> eommenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time atter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked at an}�time for due cause. <br /> � , <br /> � <br /> � Q_ �3., � y�. <br /> , �-3 , � <br /> Applicant Permitee Signature � Date [ssued By Signature Date <br />