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` CITYOFORONO * 201Z - 00373 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: OS/08/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2215 BAYVIEW PL <br /> PIN : 17-117-23-44-0026 <br /> LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B <br /> : LOT 000 BLOCK 000 <br /> PERMITTYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECT[ON <br /> NO"l'E: WATER&SEWER DISCONNECT <br /> APPLICANT SEWER CONNECT/D[SCONNECT/REPAIR 50.00 <br /> COPPIN WATER& SEWER <br /> 864 QUAIL PKWY WATER CONNECT/D[SCONNECT/REPAIR 50.00 <br /> WATERTOWN, MN 55388- STATE SURCHARGE SEWER&WATER 5.00 <br /> TOTAL 105.00 <br /> OWNER <br /> HAZARD,ROBERT&JOHANNE <br /> 2215 BAYVIEW PL <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 governing this type of work <br /> shall be compicd with whether or not spccified 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 /> reques[ed in wnformance with the State Building Code."Chis permit may be <br /> revoked at any time for due cause. <br /> �[�'--►-.- c:� 5 � 4� � I� � / O / / �� <br /> Applicant Permite Signature Date issu y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />