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CITY OF ORONO * z 0 1 3 - 0 1 1 5 9 * <br /> � ' 2750 KELLEY PARKWAY DATE ISSUED: 10/30/2013 <br /> ORONO, MN 55356- <br /> , (952)249-4600 FAX: (952) 249-4616 <br /> F <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 : RE-CONNECT <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 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at ime for due c se. <br /> G� /D�l 3Q l /3 / l <br /> App cant Permitee Signa re Date Issued y Si ture Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE. <br />