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i <br /> ' CITY OF ORONO * z 0 1 5 - 0 1 z 0 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/18/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1480 GREEN TREES RD <br /> PIN : 11-117-23-23-0016 <br /> LEGAL DESC : GREEN TREES ON TANAGER LAKE <br /> : LOT 006 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC PAID#4771-06/1 U1992 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER& WATER 1.00 <br /> PATNODE BROTHERS INC. MAIL-IN FEE 2.00 <br /> 2841 LANDER AVE <br /> ST. M[CHEAL,MN 55376- TOTAL 53.00 <br /> (612)919-0112 Payment(s) <br /> Minnesota State License#: sept-L3843 CHECK 3235 53.00 <br /> OWNER <br /> WILLSON,CHRIS& SARAH <br /> 1480 GREEN TREES RD <br /> WAYZATA, MN 55391- <br /> AGREEMEHT A1VD 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 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 construc[ion au[horized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of l80 days a[any[ime after work has commenced. <br /> The applicant is cesponsible 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 /> `� �� - ������ , ( � S ('� <br /> �� �`�LC�t � ��--�_ ��,� � I '- �-��� � t � � ��- <br /> Applicant Permitee Signature Date Issued By Signature Date <br />