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' � CITY OF ORONO * 2 0 1 4 — 0 PJ 9 1 5 * <br /> 2750 KELLEY PARKWAY DATE tsSU�n: 08/19/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3865 NORTH SHORE DR <br /> PIN : 17-117-23-22-0002 <br /> LEGAL DF,SC : UNPLATTED 17 1 17 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> J P SCHMITZ CONSTRUCTION COMPANY LL STATE SURCHARGE SEWER& WATER 5.00 <br /> 16450 1 17TH AVE N <br /> MAPLE GROVE, MN 55369- TOTAL 105.00 <br /> Payment(s) <br /> CHECK 11650 ]05.00 <br /> OWNER <br /> DOBRATZ, MR. & MRS. MARK <br /> 3865 NORTH SHORE DR <br /> MOUND, MN 55364- <br /> AGREEMENT AND SWORN STATEMENT <br /> I�he work for which this permit is issued shall be performed according to <br /> [he approved plans and specifications,applicable City approvals,and the <br /> Sta[e Building Code. This pennit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. Ail provisions of laws and ordinances goveming Ihis type of work <br /> shall be compied with whether or not specitied herein.This permit will <br /> expire and become n�Ql and void iY 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 conf �nce with the State Building Code.'This permit may be <br /> revoked at an e fo e. <br /> 1 <br /> '�J i <br /> � ����,�...� .� � � �� � l� <br /> Ap ' nt Per itee,i n e a�e ssu By Signature Date <br />