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� CITY OF ORONO * 2 0 1 4 — 0 0 5 4 1 * <br /> � 2750 KELLEY PARKWAY DATE tssUEn: 06/02/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1645 BOHNS POINT RD <br /> PIN : 17-117-23-11-0007 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0565 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER& WATER 5.00 <br /> UNLIMITED, INC. TOTAL 55.00 <br /> 19960 ST FRANCIS BLVD payment(s) <br /> ANOKA, MN 55303- <br /> (763)753-9867 CHECK 1008 55.00 <br /> OWivER <br /> CHURCH,JOHN & KLERISSA <br /> 1645 BOHNS PT RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> �t�he 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 Codc. This pennit is for only the work described and does <br /> not grant permission for additional or related work which requires separatc <br /> permits. nll provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construetion authorized is no[ <br /> commenced within 180 days ot�the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> Che applicant is r ponsible for assuring all required inspections are <br /> requested in c 'ormance with the State Building Code.'Chis permit may be <br /> revoked at� time for due cause. <br /> ,�// �n,���% <br /> /G-.L� _ v l l <br /> A�pplicant Pe� ' �gnature Date Issued ignature Date <br />