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CITY OF ORONO * z 0 1 6 - 0 1 z 7 1 * <br /> _ '" 2750 KELLEY PARKWAY DATE ISSUED: 10/06/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3188 NORTH SHORE DR <br /> PTN : 09-117-23-32-001] <br /> LEGAL DESC : CRYSTAL BAY PARK <br /> : LOT 000 BLOCK 004 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : RE-CONNECT <br /> NOTE: DOUBLE FEE PER SCOTT IN PUBLIC WORKS,WORK DONE WITHOUT PERMIT <br /> 04/0�/16-PER ROGER PEITSQ BUILDING OFFICIAL. SAC GRANDFATHERED IN H/U PROJECT <br /> APPLICAIYT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> TMS COMPANIES STATE SURCHARGE SEWER&WATER 1.00 <br /> 5990 MEADOWLARK LN DOUBLE FEE(AFTER-THE-FACT) 50.00 <br /> PRIOR LAKE, MN 55372- TOTAL 101.00 <br /> (612)414-5700 Payment(s) <br /> CHECK 5094 101.00 <br /> OWNER <br /> RUCINSKI, MICHEAL&HOLLY <br /> 3188 NORTH SHORE DR <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 pennission for additional or related work which requires separate <br /> permits. All 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 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 responsibie for assuring alI required inspections are , 1 <br /> requested in conYormance with the State Building Code.This permit may be � <br /> revoked at any time for due cause. � <br /> �� � / � , - � � � � <br /> � ,V ' � / ��(_�.S L� _ � � � � <br /> l � � _ <br /> Appiicant Permitee igna ure Date Is ed Signature � Date <br />