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CITY OF ORONO * Z pJ 1 5 - 0 1 5 4 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/10/2015 <br /> � <br /> ORONO, MN 55356- <br /> ` (952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 10 MYRTLEWOOD RD <br /> PIN : 36-118-23-33-0009 <br /> LEGAL DESC : MYRTLEWOOD <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC PAID#2015-01198 1 U06/15 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> COPPIN SEWER&WATER STATE SURCHARGE SEWER&WATER 1.00 <br /> 864 QUAIL PKWY <br /> WATERTOWN, MN 55388- TOTAL 101.00 <br /> Minnesota State License#: SW-57329MR Payment(s) <br /> CHECK 3315 ]01.00 <br /> OWNER <br /> Chamberlain Capital LLC <br /> 11578 CHAMBERLAIN CT <br /> EDEN PRAIRIE,MN 55344- <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 onty 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 applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be �] � <br /> revoked a time for due use. � �'� � <br /> � <br /> �� -�,�/''"V``- � ' � � <br /> ��/�s � �1 l��--f� � I� � � �� �� <br /> Applicant Permitee Signature Date Issue By Signa e Date <br />