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� CITY OF ORONO * 2 0 1 6 - PJ 1 1 0 z * <br /> � � 2750 KELLEY PARKWAY DATE ISSUED: 10/18/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2801 FOX ST <br /> PIN : 04-117-23-34-0004 <br /> LEGAL DESC : FARVIEW <br /> : LOT 001 BLOCK 003 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCT[ON TYPE : CONNECTION <br /> NOTE: SAC PAID 4/29/1985 -PERMIT#5603 <br /> NEW SEWER CONNECTION AND SEWER MAIN EXTENSION <br /> APPL[CANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> E. J. MAYERS, INC. TOTAL 51.00 <br /> 21000 LARKIN RD Payment(s) <br /> CORCORAN, MN 55340- CHECK 5282 51.00 <br /> (612)490-0115 <br /> Minnesota State License#: SW-PB660090 <br /> OWNER <br /> NOLAND, RICHARD <br /> 2801 FOX ST <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AIVD 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 pennission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing 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 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 /> 0 C� /o �/ Fl � /� <br /> � <br /> Applicant Permitee Signature Date Issued Signature Date <br />