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� CITY OF ORONO PERMIT NO.: 2009-00112 <br /> ` 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 03/25/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3186 NORTH SHORE DR <br /> PIN : 09-117-23-32-0010 <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 /> NEDDERMEYER,GLEN STATE SURCHARGE SEWER&WATER 0.50 <br /> 709 MINNETONKA HIGHLAND LA TOTAL 50.50 <br /> LONG LAKE,MN 55356- <br /> OWNER <br /> NEDDERMEYER,GLEN <br /> 709 MINNETONKA HIGHLAND LA <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfortned 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 /> permiu. 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 assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> 16c,�'—,�L / ,�S'/ �9 i / <br /> Applicant Permitee Signature Date Issued ignature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBE BOVE. <br />