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� � <br /> CITY OF ORONO * Z 0 1 7 — 0 0 2 3 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/13/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1750 SHADYWOOD RD <br /> P[N : 17-117-23-21-0021 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 016 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STONEWOOD, LLC STATE SURCHARGE SEWER&WATER 1.00 <br /> 153 E LAKE STREET MAIL-IN FEE 2.00 <br /> WAYZATA, MN 55391- TOTAL 53.00 <br /> (612)462-4000 Payment(s) <br /> Minnesota State License#: BUIL-BC594315 CHECK 14644 53.00 <br /> OWNER <br /> SHAW,GRETCHEN&LYLE <br /> 7001 KENESTON DR <br /> EDEN PRAIRIE, MN 55346- <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 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 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 /> � <br /> � � �r' -e,c �._, � l�-i I_7 <br /> Applicant Permitee Signature Date Issued By S ature Date <br />