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CITY OF ORONO * 2 0 1 3 - P1 0 9 3 6 * <br /> �• � 2750 KELLEY PARKWAY DATE ISSUED: 09/12/2013 <br /> ORONO,MN 55356- <br /> • (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 3048 NORTH SHORE DR <br /> PIN : 09-117-23-32-0004 <br /> LEGAL DESC : CRYSTAL BAY PARK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> D.S.M.EXCAVATING STATE SURCHARGE SEWER&WATER 5.00 <br /> 2916 ENTERPRISE AVE <br /> HASTINGS,MN 55033- TOTAL 55.00 <br /> (651)480-1355 PAID WITH CC# 0444 <br /> OWNER <br /> KALLAS,KATHRYN D <br /> 11653 CEDAR PASS <br /> HOPKINS,MN 55343- <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 applicant is responsible for asswing all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time or due c use. <br /> 9��2 �i , , <br /> Applic Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />