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'�� CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 6 - 0 1 4 6 4 * <br /> DATE ISSUED: 11/22/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3907 CHERRY AVE <br /> PIN : 08-117-23-33-0027 <br /> LEGAL DESC : CRYSTAL BAY VIEW <br /> : LOT 000 BLOCK 006 <br /> PERM[T TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: WATER&SEWER DISCONNECTION PER CITY OF ORONO <br /> APPL[CANT SEWERCONNECT/DISCONNECT/REPAIR 0.00 <br /> WATERCONNECT/DISCONNECT/REPAIR 0.00 <br /> PRIDE CONSTRUCTION&EXCAVATING STATE SURCHARGE SEWER&WATER 0.00 <br /> 9450 WEST HILL ROAD <br /> WATERTOWN,MN 55388 TOTAL 0.00 <br /> (952)475-2928 <br /> OWNER <br /> 1[[,GERALD CLARK <br /> 870 CHERRY AVE <br /> MOUND, MN 55364- <br /> AGREEMENT AIYD SWORN STATEMENT <br /> The work for which[his 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 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 Ihe 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 for due cause. , <br /> �� � � �� � <br /> � �i°l l � �� <br /> Applicant Permitee Signature Date Issued B ignature Date <br />