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' ' �` CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 3 — fd 0 3 8 0 * <br /> DATE ISSUED: OS/17/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4315 NORTH SHORE DR <br /> PIN : 07-117-23-43-0028 <br /> LEGAL DESC : SAGA HILL REVISED <br /> : LOT 000 BLOCK 018 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BOLLIG & SONS, INC. STATE SURCHARGE SEWER& WATER 5.00 <br /> 11401 COUNTY ROAD 3 <br /> HOPKINS, MN TOTAL 55.00 <br /> (612)938-4433 <br /> OWNER <br /> WILLIAMS, MARTHA P <br /> 1911 BEACH LN <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 [he <br /> State Building Code. 'i�his permit is for only the work describcd and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming[his 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 require � pections are <br /> requested in conformance wi[h the Stat i " ode.This permit may be <br /> revoked at r due ca <br /> / ' <br /> / / �/ � 7/ / <br /> Applicant Permi ee Signature Date Issued y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />