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� CITY OF ORONO PERMIT NO.: 2009-00591 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 09/15/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2520 CASCO POINT RD <br /> PIN : 20-117-23-21-0017 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 004 BLOCK 006 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> OUVERSON EXCAVATING <br /> P.O. BOX 702 STATE SURCHARGE SEWER& WATER 0.50 <br /> BUFFALO, MN 55313- TOTAL 50.50 <br /> (763)479-0337 <br /> Minnesota State License#: 68968 <br /> OWNER <br /> ROCCA, MR.&MRS. <br /> 2520 CASCO PT RD <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 rela[ed work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied wi[h whether or not specified hecein.This permit will <br /> expice 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 i ormance with the State Building Code.This permit may be <br /> revo t any ti� e for due cause. <br /> � l / l �'JS � ljlS / d <br /> p ic ermitee Signature Date Issu y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />