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CITY OF ORONO HI 1 III1I II 1I 1111 II 1111 II <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/19/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 364 WESTLAKE ST <br /> PIN : 05-117-23-23-0043 <br /> LEGAL DESC : HILLSIDE PARK <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 5.00 <br /> LEADENS EXCAVATING <br /> 21520 OAKDALE DR S.A.C. 0.00 <br /> ROGERS, MN 55374- TOTAL 55.00 <br /> (612)490-4993 Payment(s) <br /> Minnesota State License#: GENR-PB643191 CREDIT CARD 2654 55.00 <br /> OWNER <br /> Identisys,Inc. <br /> SHIELDS TRUSTEES,JANELLE K&MICHAEL R <br /> 7630 COMMERCE WAY <br /> EDEN PRAIRIE,MN 55344- <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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due se. <br /> ' <br /> Applicant Permitee Signature Date Issued By iinature Date <br />