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' " , CITY OF ORONO * 2 0 1 4 — 0 0 9 1 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/19/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1645 SHADYWOOD RD <br /> PIN : 17-117-23-22-0013 <br /> LECAL DESC : UNPLATTED 17 117 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 /> STATE SURCHARGE SEWER& WATER 5.00 <br /> J P SCHMITZ CONSTRUCTION COMPANY LL WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 16450 1 l7TH AVE N TOTAL 105.00 <br /> MAPLE GROVE, MN 55369- <br /> Payment(s) <br /> CHECK 11650 55.00 <br /> CHECK 11650 50.00 <br /> OWNER <br /> LANDSOURCE <br /> 550 25TH AVE N <br /> ST CLOUD, MN 56301- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and the <br /> State f3uilding Code. 't'his permit is for only the work described and does <br /> nof grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or nol 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 /> I he applicant is responsible for assuring alI required inspections are <br /> rcquested in confori an i l e State Building Code.This permit may be <br /> revoked at an im du caus <br /> - <br /> _._ - <br /> /�Za ��i, � � °°�C��- � � l`' � < <br /> Applicant Permitee � re Date � Issued By Signature Date <br />