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✓ � <br /> CITY OF ORONO PERMIT NO.: 2009-00923 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE ISSUE�: 12/3U2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 50 MYRTLEWOOD RD <br /> PIN : 36-118-23-33-0006 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0446 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC CHARGF,WAS PAID ON PERMIT#2009-0092113Y HOMEOWNGR-STEVEN CHAMPLIN <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> EARL W. DAY& SONS, INC. WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> P.O. BOX 294 <br /> LONG LAKE, MN 55356 STATE SURCHARGE SEWER&WATER 0.50 <br /> () TOTAL 100.50 <br /> OWNER <br /> CHAMPLIN, MR. &MRS. <br /> 50 MYRTLEWOOD RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and d�e <br /> State Building Code. This permit is for only the work described and does <br /> not grant pennission 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 whe[her 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 I 80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance wid�the State Building Code.This permit may be <br /> re ol�ed at any ir e for due cause. <br /> t �. i � �f <br /> ` ,J'-G",� .�.. �.3-- / �i ( / L'�" l l <br /> App(icant P rmitee Signature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK O HER THAN DESCRIBED ABOVE. <br />