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- CITY OF ORONO PERMIT NO.: 2010-00212 <br /> 2750 KELLEY PARKWAY <br /> ' ORONO, MN 55356- DATE ISSUED: 04/12/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3530 NORTH SHORE DR <br /> PIN : 08-117-23-43-0010 <br /> LEGAL DESC : BALDUR PARK <br /> : LOT 004 BLOCK 002 <br /> PERMIT TYPE : SEVJER <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�TSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SAC GRANDFATHERGD IN-CR�D1T GNL;N <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> DAVE'S EXCAVAT[NG INC. STATE SURCHARGE SEWER& WATER 0.50 <br /> 16110 HALSEY AVENUE TOTAL 50.50 <br /> CARVER,MN 55315- <br /> (952)448-3642 <br /> Minnesota State License#: 075981 RP <br /> OWNER <br /> ACKERMANN, ALBERT <br /> 3530 NORTH SHORE DR <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc 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 I3uilding 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 ofwork <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 I 80 days at any time after work has commenced. <br /> The applicant is res sible for assuring all required inspections are <br /> requested i co r ance with t e State Building Code.This permit may be <br /> revoke y ti e for du se � � <br /> � a l� � � <br /> Applicant Permitee Si nature Date Issued By Si ure D <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCRIBED ABOV <br />