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� � CITY OF ORONO * Z@ 1 6 - 0 1 3 8 4 * <br /> 2750 KELLEY PARKWAY ppT�[SSUEu: 10/3U2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1535 BOHNS POINT RD <br /> PIN : 08-117-23-44-0025 <br /> LEGAL DESC : BOHNS POINT WEST <br /> : LOT 1 BLOCK 1 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER CONNECTION 4"PIPE SIZE SCHD 40 MATERIAL <br /> APPLICANT SEWERCONNECT,'DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER I.00 <br /> J S STEWART COMPANIES, INC. MAIL-IN FEE 2.00 <br /> 11030 LAMONT AVE NE <br /> HANOVER, MN 55341 TOTAL 53.00 <br /> �� Payment(s) <br /> CHECK 7385 53.00 <br /> OWNER <br /> MOITZ,TODD A <br /> 100 3RD AVE S, SUTIE 3601 <br /> MINNEAPOLIS,MN 55401- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for�hich this permit is issued shall be performed according[o <br /> the approved plans and specifications,applicable City approvals,and the <br /> State[3uilding Code. This permit is for only the work described and does <br /> not grant permission for additional or related�aork which requires separate <br /> permits. All provisions of la�vs and ordinances goveming this type of work <br /> shall be compicd with whether or not specitied herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of die 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 /> L o ,2 �� l� i �l i� (o <br /> Applicant Permitee Signature Date [ssucd ignature Date <br />