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, , *. . � <br /> � ` � '* � • CITY OF ORONO * Z 0 1 3 - P1 0 4 3 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/3U2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3805 NORTH SHORE DR <br /> PIN : 17-117-23-21-0029 <br /> LEGAL DESC : SHERRI LAKEVIEW ESTATES <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: NEW CONNECTION WATER&SEWER <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER&WATER WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 6501 CO. RD 15 <br /> MOLJND,MN 55364 STATE SURCHARGE SEWER&WATER 5.00 <br /> (952)472-4959 MAIL-IN FEE 2.00 <br /> Minnesota State License#: 1804 TOTAL 107.00 <br /> PAID WITH CC# 7464 <br /> OWNER <br /> RACHEL,DON <br /> 3805 NORTH SHORE DR <br /> MOLJND,MN 55364- <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 sepazate <br /> permits. 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 d cause. <br /> �' 3-i �� i l ��yti�L s i� / i l3 <br /> Applicant Permitee S� nature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />