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.� CITY OF ORONO * Z 0 1 6 - 0 0 3 2 6 * <br /> „ 2750 KELLEY PARKWAY DATE ISSUED: 04/04/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 559 PARK LA <br /> PIN : 06-117-23-41-0044 <br /> LEGAL DESC : MINNETONKA SUMMIT PARK <br /> : LOT 000 BLOCK 006 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC PAID 4228- 10/21/1975 <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> WESTONKA SEWER&WATER <br /> 6501 CO.RD 15 TOTAL 51.00 <br /> MOiJND,MN 55364 Payment(s) <br /> (952)472-4959 CREDIT CARD 8752 51.00 <br /> Minnesota State License#: BUIL-1804 <br /> OWNER <br /> O'DONNELL,'I'IMOTHY&JOAN <br /> 559 PARK LA <br /> LONG LAKE,MN 55356- <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 gran[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 l80 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the tate Building Code.This permit may be /� <br /> revoked at any time for due au . <br /> ' � � I �✓ � �C�,�"��J '--'v / / <br /> App icant Permitee Signature Date Issued By Signature Date <br />