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� y <br /> CITY OF ORONO PERMIT NO.: 2009-00483 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE IssuEn: 08/12/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2100 SHADYWOOD RD <br /> PIN : 17-117-23-31-0041 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 030 BLOCK 001 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> NOTE: <br /> SEWER CONNECTION-4"PIPE-SCHEDULE 40 <br /> WATER CONNECTION- 1"PIPE-POLY <br /> APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER&WATER SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 6501 CO.RD 15 <br /> MOUND,MN 55364 STATE SURCHARGE SEWER&WATER 0.50 <br /> (952)472-4959 TOTAL 100.50 <br /> Minnesota State License#: 58019PM <br /> OWNER <br /> MARHULA,DAREN <br /> 2100 SHADYWOOD RD <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 goveming 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 aze <br /> requested in conformance with e State Building Code.1'his permit may be <br /> revoked at � e for du e. <br /> � � l �/ Q� / / <br /> Applicant Permitee Sign re Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />