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CITY OF ORONO PERMIT NO.: 2010-01142 <br /> ` 2750 KELLEY PARKWAY <br /> ` ORONO, MN 55356- DATE �SSUEn: 1U19/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3095 NORTH SHORE DR <br /> PIN : 09-117-23-32-0014 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0670 <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 /> WESLEY BERDICKSON STATE SURCHARGE SEWER&WATER 5.00 <br /> 6705 HIGHWAY 12 TOTAL 55.00 <br /> MAPLE PLAIN, MN <br /> (763)479-1107 PAID WITH CASH 55.00 <br /> OWNER <br /> COLE, RANDY <br /> 2959 LAKESHORE AVE <br /> MEDINA, MN 55359 <br /> AGREEMENT AND SWORN STATEMENT <br /> The worh for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and thc <br /> State Building Code. This permit is for only the work described and does <br /> no[grant permission for additional or related work which requires separate <br /> permits. nll provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not speeified 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 wnstruction is <br /> suspended for a period of 180 days at an��time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conf�rmance th[he Sta[e[3uilding Code.This permit may be <br /> r ed anyti e f��ause. r— • �i�� �{—�� � <br /> � <br /> - Cn vi iZ� �� ���.��^ l i <br /> cant G ' gna re Dat Issued By Si ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />