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�--�" CITY OF ORONO * 2 0 1 3 - 0 0 4 4 7 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 06/05/2013 <br /> ,'' � ORONO, MN 55356- <br /> 49-4600 FAX: 952) 249-4616 � <br /> ADDRESS : 1 f,�'PL r-{�l <br /> pIN : 08-117-23-33-0024 <br /> J '��(J" <br /> LEGAL DESC : CRYSTAL BAY VIEW ' �[�� 2,� <br /> : LOT 000 BLOCK 005 (^� � <br /> PERMIT TYPE : SEWER v <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: NEW SEWER CONNECTION <br /> �I � <br /> S�`' �° <br /> �/ /x <br /> � �� <br /> �� � <br /> Q�e�" <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER&WATBR STATE SURCHARGE SEWER&WATER 5.00 <br /> 6501 CO.RD 15 TOTAL 55.00 <br /> MOUND,MN 55364 PAID WITH CC# 7464 <br /> (952)472-4959 <br /> Minnesota State License#: 1804 <br /> OWNER <br /> DONGOSKE,MARK <br /> 1445 CHERRY PL <br /> MOLTND,MN 55364- <br /> AGREEMENT AND 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 sepazate <br /> permits. All provisions of laws and ordinances goveming this type of work , <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and hecome 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 applicant is responsible for as urin all required inspections aze <br /> requested in conformance ' e t Building Code.This permit may be <br /> revoked at any f e c se <br /> � � �3 �� �o � � <br /> App ' an ermitee ignature Date Issued y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />