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CITY OF ORONO PERMIT NO.: 2011-00415 <br /> 2750 KELLEY PARKWAY <br /> ' ORONO, MN 55356- �ATE IssuED: 06/03/2011 <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 t�iC�CONNECTION <br /> NOTE: RE-CONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BOLLIG& SONS, INC. STATE SURCHARGE SEWER& WATER 5.00 <br /> 11401 COLJNTY ROAD 3 <br /> HOPKINS,MN TOTAI, 55.00 <br /> (612)938-4433 <br /> OWNER <br /> SIME,MICHAEL& PAMELA <br /> 1592 MEDINA RD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> Sta[e Building Code. This permit is for only the work described and does <br /> not grant pennission 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 no[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 are <br /> requested in conformance with the Sta uilding Code.This permit may be <br /> revoked at any time for c ��' <br /> � �L"� � S� / �� <br /> Applicant Permitee Signature Date / / <br /> Issued By � ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />