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PERMIT <br />CITY OF ORONO PERMIT TYPE: <br />2750 Kelley Parkway • P.O. Box 815 Permit Number. `EWER & WATER <br />i'►n5C►;;2 <br />Orono, Minnesota 55356-0815 Date Issued i i41` , <br />(612) 473-7357 '3 <br />/''t { <br />SITE ADDRESS: <br />3403 EASTLAKE i <br />LSV <br />F. I. N . ; t�.�-117-:{-14—C►i ►F.i ► <br />DESCRIPTION: <br />SAC ONLY <br />Sewer & Water Permit. Type SAC ONLY <br />Sewer & Wager Work -type RE:.'IDENCE. <br />REMARKS: <br />FEE SUMMARY: <br />Base Fee ------- 115Q Q <br />Total Fee $75i ► . 00 <br />CONTRACTOR: <br />CITY OF DRW <br />FINANCE OFFICE <br />1< <500000 <br />01 6EN 750.00 <br />CIECK A 750.00 <br />RECEIPT-Tlft' YOU <br />#-70610 C001 R01 T10: <br />OWNER: - Applicant - <br />BE NI i I T GERALD <br />: 403 EASTLAK.E ST <br />ORONO MN 55:35F, <br />E.1 2 :► 476-63y <br />THE UNDERSIGNED HEREBY REQ lE' T'D5 PERM I S'3I ON TO MAKE THE REAL IMPROVEMENTS <br />c:F'E_C I F I ED AND AGREES TO DC I ALL WORK: IN STRICT COMPLIANCE WITH ALL CITY OF <br />ORONO GIRD I NANCES AND STATE I- F M I NNESO TA BUILDING CODE REQUIREMENTS. <br />L <br />11 <br />APPLICANT P ITEE SIGNATURE <br />ell <br />ISSUEDBY SIGNATURE <br />