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4 DI :Au M <br />CITY OF ORONO PERMIT TYPE: ':;EWER WATER <br />1335 Brown Rd. South • P.O. Box 66 Permit Number 00 4884 <br />Crystal Bay, Minnesota 55323 Date Issued 12�23��t <br />(612) 473-7357 <br />SITE ADDRESS: <br />2165 C � IL I N OR <br />F' 1 fd Cts -1 17-2-21- .,1-001 j <br />DESCRIPTION: <br />REPAIR SYSTEM <br />'=ewer 8( Water Permit Type DRNFLD 34/13R TANN <br />I. r oT Water Wart~; Type RESIDENC:E <br />REMARKS <br />FEE SUMMARY: <br />Erase Fee,�;tj C,CI <br />Surcharge -------- �y4t) <br />'Total Fee $.E O . SC) <br />I CONTRACTOR: <br />VOLK:ENANT t'I '_;CSN' INC <br />10:30 CTY RD 8' <br />MAPLE PLAIN MN <br />(C,1--) tT-1-15471 <br />- Applicant - <br />5479154? <br />5.5 59 <br />OWNER: <br />L.ARL I N6 <br />2165 <br />ORCINO <br />CITY OF GROW <br />FINAIIX CEFICE <br />A,14 �POOV <br />v: GEry 50.00 <br />. -;.- �rr0 <br />0J &EN p.50 <br />Ti � 50.50 <br />T1 <br />JOHN <br />C:i i- I ht DR <br />t;N r.5 SSC, <br />THE UNDERt ,IGNED HEREBY REIQUE'_:T' PERM I':' IC)N TO MA' -:E THF REAL IMPROVEMENTS <br />SPECIFIED AND AGREES, TI! 00 ALL WORK IN '3T1-; I C r CCIMPL I ANGE WITH ALL CITY OF <br />L C.! CtNO GIRDINANC !:_: AND '=LTATE OF MINNE:ii-IA E;t)ILEIING (_:iIi+- F;Fi;�ttIRLMENT'�:. <br />— <br />APPLICANT PERMITEE SIGNATURE " ISSUED 1Y SIGNATURE <br />