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5 aiy <br /> CITY OF ORONO * 2 0 1 6 - 0 0 8 8 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/26/2016 <br /> ORONO,MN 55356- <br /> (952 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2040 SPATES AVE <br /> PIN : 10-117-23-31-0090 <br /> LEGAL DESC : ORA PARK ON LAKE MTKA <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> METRO EARTHWORKS TOTAL 51.00 <br /> 18950 TERRITORIAL ROAD Payment(s) <br /> MAPLE GROVE,MN 55369- CREDIT CARD 6037 51.00 <br /> (763)4643512 <br /> Minnesota State License#:SW-4531 <br /> OWNER <br /> DAMMEN,SUSAN <br /> 2040 SPATES AVE <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pern►it is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This pennit is for only[he 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.'fhis 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at time fo e cause. <br /> � � <br /> L l 25U � l�l �,C� <br /> Appl' ant P itee Signatur Date Issued B ignature Date <br />