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1' CITY OF ORONO � <br /> � * 2 0 1 7 - 0 0 6 8 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/22/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1750 SHADYWOOD RD <br /> PIN : 17-117-23-21-0021 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 016 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�TSTRUCTION TYPE : CONNECTION <br /> NOTE: WATER AND SEWER RECONNECTION <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPA[R 50.00 <br /> COPPIN SEWER&WATER WATERCONNECT/DISCONNECT/REPAIR 50.00 <br /> 864 QUAIL PKWY STATE SURCHARGE SEWER&WATER 1.00 <br /> WATERTOWN, MN 55388- TOTAL 101.00 <br /> (612)508-9974 Payment(s) <br /> Minnesota State License#: SW-57329MR CHECK 5405 101.00 <br /> OWNER <br /> SHAW,GRETCHEN&LYLE <br /> 7001 KENESTON DR <br /> EDEN PRAIRIE,MN 55346- <br /> AGREEMENT AIYD 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 /> ` •. _� ., . .;�, -� 1 ;,�Q `f'-�� /o�oZl � <br /> Applicant �ermitee;Signa re Date Issued By ignature Date <br />