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- <br /> T <br /> � • <br /> CITY OF ORONO * z 0 1 3 - 0 1 2 7 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/06/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4055 ELM ST <br /> PIN : 06-117-23-41-0106 <br /> LEGAL DESC : MINNETONKA SUMMIT PARK <br /> : LOT 000 BLOCK 009 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECI'ION <br /> NOTF:: SEW'I��:R CONNf?CT1UN -4" PIPP. <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER& WATER 5.00 <br /> BURSCH BROTHERS INC. TOTAL 55.00 <br /> Y.O. BOX 55 <br /> HANOVER, MN 55341 Payment(s) <br /> (612)221-1493 CHECK 18389 55.00 <br /> Minnesota State License #: BUIL-2727 <br /> OWNER <br /> FRITZ, MATT <br /> 9125 LOUISIANA AVE N <br /> BROOKLYN PARK, MN 55443- <br /> AGREEMEIVT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applieable City approvals,and the <br /> State Building Code. This permit is tbr only[he work described and does <br /> not grant pemlission fbr 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 speciYied herein.This permit 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 /> requestcd in conformance with the State Building Code.This permit may bc <br /> revoked at an}�time for due cause. <br /> ��"�___� �Z--�-i 3 � �-i � i /3 <br /> Applicant Permitee Signatw�e Date Issu d By Signature Date <br />