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' ` CITY OF ORONO <br /> * Z 0 1 3 - 0 0 0 3 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OU15/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2789 PHEASANT RD <br /> PIN : 21-117-23-32-0005 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0310 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: WAT[;R&SEWER DISCONNGCT <br /> APPLICANT $EWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> D.S.M. EXCAVATING WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 2916 ENTERPRISE AVE <br /> HASTINGS, MN 55033- STATE SURCHARGE SEWER& WATER 5.00 <br /> (651)480-1355 TOTAL 105.00 <br /> PAID WITH CC# 9252 <br /> OWNER <br /> TEYNOR, GAIL&JOSEPH <br /> 13225 CARDINAL CREEK RD <br /> EDEN PRAIRIE, MN 55346- <br /> AGREEMENT AND SWORN STATEMENT <br /> I'he work for which this permit is issued shall be performed according to <br /> the approved plans and specilications,applicable Ciry approvals,and the <br /> State Building Code. This permit is lor only the work described and does <br /> not grant permission for additional or related work which rcquires separate <br /> permits. All provisions of laws and ordinances governing this type of wark <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 atter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in eonformance with the State Building Code.This permit may be <br /> revoked at an tin for e c use. �� <br /> � ' �5 ' �3 �' ���l���t ��z � � �-;� �; <br /> Applicant Permitee Signature Date <br /> Issued, �Signaturc Datc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />