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CITY OF ORONO * z 0 1 4 - 0 1 1 4 1 * <br /> � � 2750 KELLEY PARKWAY DATE ISSUED: 10/06/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 71 1 SANDSTONE CIR <br /> PIN : 33-118-23-i1-0045 <br /> LEGAL DESC : STONEBAY <br /> : LOT 042 BLOCK 001 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: WATER&SGWER CONNf?CTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> T&J CONCRETE WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> 9100 BALTIMORE STREE7'NE STATE SURCHARGE SEWER& WATER 5.00 <br /> BLAINE, MN 5�449- TOTAL 105.00 <br /> (763)413-0988 Payment(s) <br /> Minnesota State License#: SW-6461 12,GENR-PB6461 12 CHECK 142�3 105.00 <br /> OWNER <br /> Stonebay Builders LLC <br /> 14870 BROCKTON LA <br /> DAYTON, MN 55327- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approvcd 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 permission for addi[ional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied wi[h 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 construetion is <br /> suspended fi�r a period of I 80 days a[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 Coda This permit may be <br /> revoked at any timc for due cause. <br /> � <br /> � � � �� �� �� � ����� <br /> Applicant Permitee Signature Date Issu By Signature Date <br />