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, CITY OF ORONO * 2 0 1 6 - 0 0 8 1 6 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 07/15/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1885 CONCORDIA ST <br /> PIN : 17-117-23-23-0002 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�ISTRUCTION TYPE : RE-CONNECT <br /> NOTE: SAC GRANDFATHERED IN 2316 ON 10/29/1969 AND HOME PRIOR <br /> RE-CONNECTION ONLY <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> COPPIN SEWER&WATER STATE SURCHARGE SEWER&WATER 1.00 <br /> 864 QUAIL PKWY <br /> WATERTOWN,MN 55388- TOTAL 101.00 <br /> (612)508-9974 Payment(s) <br /> Minnesota State License#: SW-57329MR CHECK 4968 101.00 <br /> OWNER <br /> KAISER,BERNARD&CAROLYN <br /> 2855 PROVIDENCE PLACE <br /> INDEPENDENCE, MN 55359- <br /> AGREEMEI�T 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 relatcd work which requires separate <br /> pernlits. All 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 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 with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � f/ jj <br /> 1<i. <br /> . , � �c�- � �l � � ��. .._�����::o�; ' 1 � <br /> 1��-�^-- C.�YYw-r S - ��` �� i / � �/ ( �... <br /> � <br /> Applicant Permit e Signature Date Issued By Signature Date <br />