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CITY OF ORONO MI 114 I 111' 1111' 1 ' <br /> * 20 1 4 - 00 4 SS * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/15/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 625 OLD LONG LAKE RD <br /> PIN : 36-118-23-32-0003 <br /> LEGAL DESC : UNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: 2014 SEWER ASSESSMENT PAID BY CLOSING COMPANY ON SAME CHECK AS SAC&PERMIT FEE- <br /> PAID BY HOME TITLE,INC.CK#44-433410 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 205.00 <br /> STATE SURCHARGE SEWER&WATER 5.00 <br /> ELMER J.PETERSON COMPANY S.A.C. 2,485.00 <br /> 5921 DAGUE AVE SE TOTAL 2,695.00 <br /> DELANO,MN 55328 <br /> (763)972-2420 Payment(s) <br /> Minnesota State License#: BUIL-219 CHECK 44-43341 2,685.00 <br /> CHECK 44-43441 10.00 <br /> OWNER <br /> SHEREK,MATTHEW&AMY <br /> 625 OLD LONG LAKE RD <br /> WAYZATA,MN 55391- <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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> Applicant Permitee Signature Date Issued By Signature Date <br />