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CITY OF ORONO PERM�T�vo.: Zoiaoos3s <br /> � ` 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuEn: 06/29/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2172 SHADYWOOD RD <br /> PIN : 17-117-23-42-0010 <br /> LEGAL DESC : WILEYS PARK LAKE MTKA <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : RE-CONNECT <br /> NOTE: SAC CREDIT-GRANDFATHERED IN <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> AREA WIDE PLUMBING WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 9989 190TH ST. STATE SURCHARGE SEWER&WATER 0.50 <br /> SILVER LAKE, MN 55381- <br /> (952)292-5297 TOTAL 100.50 <br /> Minnesota State License#: 61937-PM <br /> OWNER <br /> DORE, STEVEN <br /> 8351 WEST 109TH STREET <br /> BLOOMINGTON, MN 55438- <br /> AGREEMENT AND SWORN STATEME1vT <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 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 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 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 are <br /> requested in conformance with the ate Building Code.This permit may be <br /> revoked at a�,ti#� ue cause � 2 � ��ZR �� <br /> l ^7 / �'� ��� � 6Y►�lC�N l l � <br /> Applicant ermitee Signature Date Issued By ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />