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CITY OF ORONO PERMIT NO.: 2011-01211 <br /> � 2750 KELLEY PARKWAY <br /> . � ORONO, MN 55356- �ATE 1SSUED: 10/07/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1200 LOMA LINDA AVE <br /> PIN : 08-117-23-23-0027 <br /> LEGAL DESC : SAGA HILL REVISED <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: DISCONNECT"11 IE CONNEC"I�ION TO THE COTTAGE ONLY! <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 <br /> 6501 CO. RD 15 TOTAL 55.00 <br /> MOUND, MN 55364 <br /> (952)472-4959 PAID WITH CC# 7464 <br /> Minnesota State License#: 1804 <br /> OWNER <br /> ETAL, EDMUND GRIFFIN <br /> 1210 LOMA LINDA AVE <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> "I�he work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> Sta[e 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 /> pennits. All provisions of laws and ordinances goveming this typc of work <br /> shall be compied wi[h whether or not specified herein.This permi[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 construcfion is <br /> suspended for a period of l80 days at any time aYter work has commenced. <br /> The applicant is responsible for assuring all required inspections are �� <br /> requested in conformance wi he State Building Code.This permit may be � <br /> revoked y time fo � c se. <br /> -� r �� <br /> i <br /> �� l � l � / ���C_�( C`�/l�l ('C-�� � Y 7- /� <br /> App icant Per ' ee ignature Date Issued By S gnature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />