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CITY OF ORONO * Z p� 1 5 - 0 1 4 9 4 * <br /> �� 2750 KELLEY PARKWAY DATE ISSUED: 1U20/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1380 BRIAR ST <br /> PIN : 10-117-23-31-0053 <br /> LEGAL DESC : MARKVILLE <br /> : LOT 000 BLOCK 002 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTTON TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION <br /> APPLICAIVT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER& WATER 1.00 <br /> OUVERSON SEWER&WATER TOTAL 51.00 <br /> P O BOX 247 <br /> LORETTO, MN 55357- Payment(s) <br /> Minnesota State License#: SW-MR86668 CREDIT CARD 9781 51.00 <br /> OWNER <br /> ZITZLOFF,JEFFREY&BRENDA <br /> 1380 BRIAR ST <br /> WAYZATA,MN 55391- <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 goveming this type of work <br /> shall be compied wi[h 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 c se. <br /> �' �� � ! ��' � — �� ^ ll l ��l !� <br /> Applicant Permitee StgnaturL✓' Date Issued ignature Date <br />