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CITY OF ORONO * z 0 1 5 - m 0 1 2 5 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 02/02/2015 <br /> ORONO, MN 55356- <br /> � 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 960 FERNDALE RD W <br /> PIN : 02-117-23-44-0017 <br /> LEGAL DESC : COUNTRY CLUB ESTATES <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTTON TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNGCT <br /> APPLiCAI�IT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 5.00 <br /> J S STEWART COMPANIES, INC. MAIL-IN FEE 2.00 <br /> 11099 LAMONT AVE NE TOTAL 57.00 <br /> HANOVER, MN 55341 <br /> �� Payment(s) <br /> CHECK 6087 57.00 <br /> OWNER <br /> BROOKS,JOHN&JOAN <br /> 960 FERNDALE RD W <br /> WAYZATA,MN 55391- <br /> AGREEMENT AIYD 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 addi[ional 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 afrer 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 Yor due cause. <br /> � L�/� <br /> J �l � �1,�,� _. � � ( �yn c� �� 2-- � �Z � r��. <br /> Applicant Permitee Signature Date Issued By Signature Date <br />