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� � CITY OF ORONO * 2 0 1 4 - 0 1 z 7 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/31/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3405 CRYSTAL BAY RU <br /> PIN : 17-117-23-44-0022 <br /> LEGAL DESC : WALLACES ADDN �'O VIL OF MTKA B <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTG: SEWr;R RE,PAIR <br /> APPLICANT SEWER CONNF,CT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER& WATER 5.00 <br /> WESTONKA SEWER & WATER <br /> 6501 CO. RD l5 TOTAL 55.00 <br /> MOUND, MN 55364 Payment(s) <br /> (952)472-4959 CHECK 10859 55.00 <br /> Minnesota State License#: QUIL-1804 <br /> OWNGR <br /> SWEET, CnTHERINE <br /> 3405 CRYSTAL BAY RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The Hork for which this permit is issued shall be performed accordine to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This permit is for only thc work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. nll provisions of laws and ordinances governing 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 I80 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time atter work has commenccd. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformancc witkrf#je State Building Code.This permit may be <br /> revoked a �me fo caus <br /> ��� , / <br /> ��--�� /� � � /O ��-1 �/ <br /> Applicant Permitee Signature Date Issucd E ��Signature Date <br />