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, CITY OF ORONO *��J 1 4 — (d 0 9 1 8 * <br /> . 2750 KELLEY PARKWAY DATE ISSUED: 08/19/2014 <br /> � ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS ; 60 MYRTLEWOOD RD <br /> PIN : 36-118-23-33-0020 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0446 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : PASS THROUGH FEES <br /> N OTE: <br /> PAID VIA: CK#2451}'OR$2712.00 FOR THE SEWER&WATER PASS THROiJGH FEES&CK#2451$2485.00 FOR THE SAC CHARGES. <br /> APPLICANT SEWER CONNECTION CHARGE- WAYZATA 590.00 <br /> WATER CONNECT]ON CHARGE- WAYZATA 2,122.00 <br /> HARTMAN, TODD S.A.C. 2,485.00 <br /> 60 MYRTLEWOOD RD <br /> WAYZATA, MN 55391- TOTAL 5,197.00 <br /> � Payment(s) <br /> CHECK 2451 5,197.00 <br /> OWNER <br /> HARTMAN, TODD <br /> 60 MYRTLEWOOD RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work f�or which Ihis permit is issucd shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State Building Code. This permit is for onl��the work described and does <br /> not grant permission lor additional or related work which requires scparate <br /> permits. All provisions of laws and ordinances goveming this rype of work <br /> shall be compied with whether or not specilied herein This permit will <br /> expire and become null and void if�construction authorized is not <br /> commenced within 180 days of the da[e of issuance,or if construction is <br /> suspended for a period of 180 days at any time atter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in confomiance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> \ Lv / � / / <br /> pp ieant Permj ee Signature Date Issued By �gnature ,,L„� Date <br /> / O\ <br />