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r CITY OF ORONO * 2 0 1 6 — 0 0 5 8 7 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/25/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)2494616 <br /> ADDRESS 660 TONKAWA RD <br /> PIN 05-117-23-33-0016 <br /> LEGAL DESC PARTENS POINT 1ST DIV <br /> LOT 003 BLOCK 000 <br /> PERMIT TYPE SEWER <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE CONNECTION <br /> NOTE: SEWER CONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> KOTHRADE SEWER&WATER TOTAL 51.00 <br /> 12059 WHITETAIL AVENUE Payment(s) <br /> HANOVER,MN 55341 CHECK 20033 51.00 <br /> Minnesota State License#: SW-192 MPCA <br /> OWNER <br /> LADD&CAROL STAMBROOK,MICHEAL <br /> 660 TONKAWA RD <br /> LONG LAKE,MN 55356- <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 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 ass ng all required inspections are <br /> requested in conformance with the a Building Code.This permit may be <br /> revoked at any time for due cause. <br /> )-�k t��) <br /> S-Z(0l � �v ' D/ /.� <br /> Applicant Perinitee Signature Date Issued B ignature Date <br />