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CITY OF ORONO * Z 0 1 5 - 0 1 5 4 5 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 12/10/2015 <br /> . ORONO, MN 55356- <br /> (952) 249-4600 FAX: 952) 249-4616 <br /> ADDRESS : 1135 HERITAGE LA <br /> PIN : 10-117-23-13-0021 <br /> LEGAL DESC : FOXHILL <br /> : LOT 000 BLOCK 003 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC&SPEICAL SEWER PROJECT FEE PAID#2015-01541 12/09/15 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER& WATER 1.00 <br /> BURNS EXCAVATING,INC. TOTAL 51.00 <br /> 3470 CO.RD 21 <br /> MAYER,MN 55360- Payment(s) <br /> (612)685-4303 CHECK 26988 51.00 <br /> Minnesota State License#: SW-1888 <br /> OWNER <br /> HOFFMAN, BARBARA J <br /> 1135 HERITAGE LA <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMEIVT <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 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 app(icant is responsible for assuring all required inspections are <br /> reques[ed in conformance with[he State Building Code.This permit may be <br /> revoked at any time for due cause. y���/7 <br /> � _ � � �� �- - <br /> ����-- �s '����-� ,��--��� �t � , � �_ , 1 � <br /> � <br /> Applicant Permitee Signature Date fssued By Signature Date <br />