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CITY OF ORONO PERMIT NO.: 2009-oo6s9 <br /> � � 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DA7'E [ssuEu: 10/09/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 110 CREEK RIDGE PASS <br /> PIN : 03-117-23-12-0015 <br /> LEGAL DESC : CREEKSIDE IN ORONO <br /> : LOT 004 BLOCK 001 <br /> PERM[T TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTF.: SAC COLLECTED WITH BUILDING PERMI"1�2009-00475 <br /> APPLICANT SEWER CONNECT/D[SCONNECT/REPA[R 50.00 <br /> UP NORTH MECHANICAL STATE SURCHARGE FLAT-OTHER 0.50 <br /> 43900 ELMCREST AVE <br /> P.O. BOX 35 TOTAL 50.50 <br /> HARRIS, MN 55032 <br /> (65 I)277-0515 <br /> OWNER <br /> JOHNSON, ANDREW <br /> 4215 TRILLIUM LN E <br /> MOUND, MN 55364- <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 gran[permission for addi[ional 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 /> 'rhe applicant is responsible for assuring all required inspections are <br /> reques[ed in conformance with the State Building Code.This permit may be <br /> rev ke ny time for due cause. <br /> i j C '� , C� <br /> / / <br /> ' nt Permitee ignature Date Issued By Si n ture te <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABO <br />