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IIIILII <br /> 1' '1' <br /> .- CITY OF ORONO <br /> * <br /> 2750 KELLEY PARKWAY * 2 0 1 6 - 0 1 4 8 9 <br /> DATE ISSUED: 12/01/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 570 ORONO ORCHARD RD S <br /> PIN : 1000181 <br /> LEGAL DESC : MINNETONKA BLUFFS <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECT <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> WESTONKA SEWER&WATER TOTAL 51.00 <br /> 6501 CO.RD 15 <br /> MOUND,MN 55364 Payment(s) <br /> (952)472-4959 CREDIT CARD 1685 51.00 <br /> Minnesota State License#:BUIL-1804 <br /> OWNER <br /> JAGLO&JOHN BRUNELLO,JEFF <br /> 570 ORONO ORCHARD RD S <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 d - ca <br /> Z —/6 10 - . <br /> i ..,,k_s_ f-c-,-- <br /> e—"ee ure Date r Date <br /> SignaIssued By Signature <br />