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- CITY OF ORONO * 2 0 1 6 - 0 1 0 7 1 * <br /> y 2750 KELLEY PARKWAY DATE ISSUED: 08/3U2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 940 NORTH ARM DR <br /> PIN : 07-117-23-11-0014 <br /> LEGAL DESC : PIRATES COVE <br /> : LOT O10 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER CONNECTION <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> WESTONKA SEWER&WATER TOTAL 51.00 <br /> 6501 CO.RD 15 Payment(s) <br /> MOLJND,MN 55364 CREDIT CARD 1685 51.00 <br /> (952)472-4959 <br /> Minnesota State License#:BUIL-1804 <br /> OW1�1ER <br /> OLSHANSKY,ROMAN <br /> 76 KINGSVIEW LANE N <br /> PLYMOUTH,MN 55447- <br /> AGREEMENT AND SWORN STATEME1vT <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 pertnit is for only the work described and does <br /> no[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 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 a required inspections are <br /> requested in conformance with the Stat uilding Code.This permit may be <br /> revoked at ' e for due se ^ /f 9� <br /> � �� l� ��-E��,VIY <br /> I�-� � � � �1 � <br /> Applicant Permitee Signature Date Issued By S�ig�r►ature Date <br />