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.s. <br /> CITY OF ORONO PERMIT NO.: 2011-00190 <br /> 2750 KELLEY PARKWAY <br /> � ORONO, MN 55356- DATE �SSUED: 03/3U2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : l20 CREEK RIDGE PASS <br /> PIN : 03-]17-23-12-0014 <br /> � LEGAL DESC : CREEKSIDE IN ORONO <br /> : LOT 003 BLOCK 001 <br /> � PERMIT TYPE : SEWER& WATER <br /> I NROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION . <br /> APPLICANT <br /> SEWER CONNECT/DISCONNECT/REPA[R 50.00 <br /> NEUTGENS EXCAVATING �,CONSTRUCTION WATER CONNECT/D[SCONNECT/REPAIR 50.00 <br /> 16230 54TH ST <br /> ST MICHAEL, MN 55376- STATE SURCHARGE SEWER& WATER 5.00 <br /> TOTAL 105.00 <br /> OWNER <br /> GUSTAFSON, MICHAEL& SUSAN <br /> 1000 SHELARD PKWY#300 <br /> MINNEAPOLIS, MN 55426- <br /> � <br /> AGREEMENT AND SWORN STATEMENT <br /> �I�he���ork for���hich Uiis permit is issucd shall be performed according to <br /> the approved plans and specifications,applicable City approvals.and the <br /> State[3uilding Code. This permit is for only the work described and docs <br /> not grant permission for additional or rclated work�vhich requires separate <br /> permits. nll provisions of laws and ordinanccs ooverninc this typc of work <br /> shall be compicd with whether or not speciticd herein.'I'his permit will <br /> expirc and bccomu null and void if construction authorized is not <br /> � commenced within I80 days of the date of issuance,or if construction is <br /> suspended lor a period of I 80 days at any time after work has commenced. <br /> Thc 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 e cause. <br /> -��� �� � �� / / <br /> � A plicant Permitec Si�natin�c Date Issued B��Si ure � Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED A OVE. <br />