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< < CITY OF ORONO * 2 0 1 5 - 0 1 PJ 9 � * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/27/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1 l05 BROWN RD S <br /> PIIv : 10-117-23-24-0004 <br /> LEGAL DESC : UNPLATTED 10 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: WATER&SEWER DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECTlDISCONNECT/REPAIR 50.00 <br /> D.S.M. EXCAVATING STATE SURCHARGE SEWER&WATER 1.00 <br /> 2916 ENTERPRISE AVE <br /> HASTINGS,MN 55033- TOTAL 101.00 <br /> (651)480-1355 Payment(s) <br /> CREDIT CARD 0444 101.00 <br /> OWNER <br /> CHRISTENSON,JERRY <br /> 1105 BROWN RD S <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 /> shail 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 cause. <br /> _ � �.' /S� �� � �a? 7� lS <br /> �� <br /> App ic nt Permitee Signature Date Iss y Signature Date <br />