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, <br /> ! w <br /> CITY OF ORONO PERMIT NO.: 2009-00694 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE [ssuE�: 10/12/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1981 FAGERNESS POINT RD <br /> PIN : 18-117-23-14-0005 <br /> LEGAL DESC : FAGERNESS <br /> : LOT 004 BLOCK 000 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NO']�E: <br /> SEWER CONNECTION-4" PIPE SIZE, PVC MATERIAL <br /> WATER CONNECTION- 1"PIPE SIZE, POLY MATERIAL <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> R[TTER EXCAVATING WATER CONNECT/D[SCONNECT/REPAIR 50.00 <br /> 7120 VERNON STREET <br /> ROCKFORD, MN 55373 STATE SURCHARGE SEWER&WATER 0.50 <br /> (612)477-5649 TOTAL 100.50 <br /> Minnesota State License#: 1921 <br /> OWNER <br /> WHITTINGTON-GGROENKE, M[CHEAL&JULIE <br /> 1981 FAGERNESS PT RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> "I'he work Yor which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State I�uilding Code. This permit is for only the wark 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 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 /> revoke�at �time � du cause. <br /> ! , � � / /L� / / <br /> A ' ant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />