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CITY OF ORONO <br /> III I III 1II.. III 11111111 II <br /> 2 750 KELLEY PARKWAY * 2 0 1 6 - 0 0 9 <br /> DATE ISSUED: 08/04/22 011 <br /> 6 <br /> ORONO,MN 55356- <br /> ( T2-l9-4600 FAX: (952)249-4616 <br /> ADDRESS : 2120 \\'.` ' ` 1..\ HIND LVD W <br /> PIN : 3,1-IIS _ nnr)I <br /> LEGAL DESC : UNPLA I ! : D3,1118 23 <br /> : LO•IT WO 11 LOCK 000 <br /> PERMIT TYPE : S1;vy'I:I. <br /> PROPERTY TYPE : RLS I I)N T I A I, <br /> CONSTRUCTION TYPE : DISCONN!V. 'ION <br /> APPLICA`"U SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> AMERICAN MECHANICAL CO, C , MAIL-IN FEE 2.00 <br /> 7120 71ST AVE.N. <br /> PO BOX 205 TOTAL 53.00 <br /> LORETTO,MN 55357- Payment(s) <br /> (612)750-0278 CREDIT CARD 6203 53.00 <br /> OWNER <br /> ERICKSON,BRAD <br /> 2486 BOBOLINK RD <br /> MEDINA,MN 55356- <br /> AGREEMENT AND SWO►." <br /> The work for which this permit is issued shall according to <br /> the approved plans and specifications,applicable Cilyvals,and the <br /> State Building Code. This permit is for only the st om k r..crihal and does <br /> not grant permission for additional or related ...... . ......cc separate <br /> permits. All provisions of laws and ordin. 'res:'m ype or work <br /> shall be compied with whether or not spec't ie l' ,.: .. a,, , t <br /> expire and become null and void if construct imsi;em' rf <br /> commenced within 180 days of the date of i«,:a:,ce.o•. ,,tioo is <br /> suspended for a period of 180 days at any. care <col,nnenced. <br /> The applicant is responsible for assuring ah.. ......, <br /> requested in conformance with the State I t• .• • 1 c ;:,,it may be <br /> revoked at any time for due cause. <br /> 11 <br /> G ► ccs Jw vco I / �I lid <br /> Applicant Permitee Signature Issued By Signature Date <br />