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CITY OF ORONO * z 0 1 4 — P1 PJ 9 1 9 * <br /> � 2750 KELLEY PARKWAY DATE ISSUEU: 08/20/2014 <br /> �,/� ORONO, MN 55356- <br /> ��j � (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS . 50 KELLEY PKWY <br /> PIN : 33-118-23-12-0007 <br /> LEGAL DESC : CITY OF ORONO ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : COMMERCIAL- BUSINESS <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTF.: SEWER&WA�I�ER DISCONNI:C�I' <br /> .�/ f'� %t�� /���7� � �; ;=;�; ��_ �.���� /�� ���,L� <br /> t ! fi: J <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 0.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 0.00 <br /> MINNESOTA UTILITIES& EXCAVA'TING STATE SURCHARGE SEWER& WATER 5.00 <br /> 13932 LAKE DRIVE <br /> FOREST LAKE, MN 55025- TOTAL 5.00 <br /> (651)464-5532 Payment(s) <br /> Minnesota State License#: SW-4188 CHECK 5004 5.00 <br /> OWNER <br /> City of Orono <br /> ORONO, CITY OF <br /> 2750 KELLEY PARKWAY <br /> P.O. BOX 66 <br /> CRYSTAL BAY, MN 55323- <br /> AGREF,MENT AND SWORN STATEMENT <br /> I�he work for which this permit is is,ued shall be performed according to <br /> the approved plans and specitications,applicablc City approvals,and the <br /> State[�uilding Code. "I�his permit is for only the work describcd and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of la�vs and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.'i�his permit will <br /> expire and become null and void i(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 arc <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> '"� X ` T . i� � i�Di <br /> pplicant Permitee ignature D' c I ed By Signature Date <br />