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CITY OF ORONO * 2 0 1 5 - 0 1 5 1 6 * <br /> _� 2750 KELLEY PARKWAY DATE ISSUED: 12/03/2015 <br /> . ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2000 SHADYWOOD RD <br /> PIN : 17-117-23-31-0001 <br /> LEGAL DESC : GUST S JOHNSONS ADDN <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: DISCONNECT ONLY <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> COPPIN SEWER&WATER WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 864 QUAIL PKWY STATE SURCHARGE SEWER&WATER 1.00 <br /> WATERTOWN,MN 55388- TOTAL 101.00 <br /> Minnesota State License#: SW-57329MR P$yment(s) <br /> CHECK 4721 101.00 <br /> OWNER <br /> Sustainable 9 Holdings LLC <br /> 124 MAIN ST SE <br /> SUITE#343 <br /> MINNEAPOLIS,MN 55414 <br /> AGREEMENT AND SWORN STATEME1vT <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 dces <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 wmpied 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 aze <br /> requested in conformance with the State Building Code.This permit may be n,n <br /> revoked at any time for due cause. ��/Y <br /> �. � <br /> ' r _ - � �U �,�- 3i 15 <br /> Applic t Permit e Si ture Date Issued By Signatur Date <br />