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. CITY OF ORONO <br /> 2750 KELLEY PARKWAY * � 0 1 z - 0 0 3 0 5 * <br /> DATE ISSUED: 04/23/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 70 MYRTLEWOOD RD <br /> PIN : 36-118-23-33-0018 <br /> LEGAL DESC : REG.LAND SURVEY NO.0446 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: INSIDE WATER CHANGE OVER <br /> APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WOODBURY MECHANICAL INC. STATE SURCHARGE SEWER&WATER 5.00 <br /> 1988 STANICH COURT TOTAL 55.00 <br /> MAPLEWOOD,MN 55109- <br /> (651)777-7950 <br /> Minnesota State License#: PJ058638 <br /> OWNER <br /> SWANSON,JOSEPH <br /> 70 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 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 separate <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 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 applic t is responsible for assuring all required inspections are <br /> request n conformance with the State Building Code.This permit may be <br /> revo at any ti f e cause. <br /> � i �3 i � Lt.., i .� �-. <br /> Applicant Permitee Signature Date I s By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />