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. � CITY OF ORONO PERMIT NO.: 2009-00880 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUEn: 12/07/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1785 CONCORDIA ST <br /> PIN : 17-117-23-22-0016 <br /> LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RES[DENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> UP NORTH MECHANICAL STATE SURCHARGE SEWER&WATER 0.50 <br /> 43900 ELMCREST AVE <br /> P.O. BOX 35 TOTAL 50.50 <br /> HARRIS, MN 55032 PAID W[TH CC# 3902 <br /> (651)277-OS 15 <br /> OW1vER <br /> DULIN, KEVIN & BARBARA <br /> 1785 CONCORDIA 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,appiicablc City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> no[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 compie whether or not specified herein."�his permit will <br /> expire and ome n II and void if construction authorized is not <br /> commen �it in 80 days of the date of issuance,or if construction is <br /> suspen for p iod of 180 days at any time after work has commenced. <br /> The plica is esponsible for assuring all required inspections are <br /> re t � c nfon with the Statc Building Code.This permit may be <br /> re o for due cause. <br /> i i �� /� a7 0� <br /> A cant Permitee Signature Date Issu Qy Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />