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_ , <br /> CITY OF ORONO * 2 0 1 3 - 0 0 7 9 0 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/13/2013 <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: SEWER RE-CONNECTION-4"PIPE <br /> WATER RE-CONNECTION- 1"PIPE <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> OLSON CONSTRUCTION CO. WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 6970 INWOOD ROAD <br /> COLOGNE,MN 55322- STATE SURCHARGE SEWER&WATER 5.00 <br /> (952)448-6674 TOTAL 105.00 <br /> Minnesota State License#: L1111 PAID WITH CC# 5490 <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 separate <br /> permits. All provisions of laws and ordinances governing 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 uilding Code.This permit may be <br /> revoked at any time fordue cause. <br /> � � � (,�'4�-( g' l �3. l /3 <br /> Applican ermitee Signatur Date Issue y Signature Date <br /> SEP RATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />