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CITY OF ORONO * z 0 1 6 - a 1�� <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1ll14/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3295 CRYSTAL [3AY RD <br /> P I N : 17-117-23-4 I-0013 <br /> LEGAL DESC e TOWNSITE OF LANGDON PARK <br /> : LOT 002 BLOCK 002 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE e RESIDENTIAL <br /> CONSTRUCTION TYPE a DISCONNECTION <br /> NOTE: DISCONNECT ONLY <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> WATI:RCONNECT/D[SCONNECT/REPAIR 50.00 <br /> SCHERBGR COMPANY, LLC STATE SURCHARGE SEWER&VVATER 1.00 <br /> 20160 75TH LANE N <br /> CORCORAN,MN 55340- TOTAL 101.00 <br /> (763)497-1100 Payment(s) <br /> CHECK 17580 101.00 <br /> OWNER <br /> GREG BLASKO, WHI"['NEY WINDMILLER <br /> 3295 CRYS'I'AL BAY RD <br /> WAYZATA. MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> 'Che work for tihich this permit is issued shall be perfomied according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work dcscribed and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing diis type of work <br /> shall be compicd 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.._...,_--...__.. <br /> �' � <br /> 1 -- � �-�� � (� C�/) ��-^�--� 7`z� Z-' ��/ �4�/ �� <br /> Ap icant Permitee Signature Date Issued I3y Signature Date <br />