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CITY OF ORONO * z 0 1 z - 0 0 7 6 0 * <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 08/06/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 325 CRESTVIEW AVE <br /> P[N : OS-117-23-14-0031 <br /> LEGAL DESC : BAYS[DE ADDN TO LAKE MINNETONK <br /> : LOT 000 BLOCK 005 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RES[DENT[AL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> APPL[CANT <br /> SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WESTONKA SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 <br /> 6501 CO. RD 15 TOTAL 55.00 <br /> MOUND, MN 55364 <br /> (952)472-4959 <br /> Minnesota State License#: 1804 <br /> OWNER <br /> SULL[VAN, WENDY <br /> 3409 26TH. AVE. S <br /> MINNEAPOLIS, MN 55406- <br /> AGREEMENT AND SWORN STATEMENT <br /> I hc work for which this pern�it 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 perniission Cor additional or rclated work which requires separate <br /> pennits. All provisions of laws and ordinances governing this type of wark <br /> shali 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 a[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 cause. <br /> �P� CZ' � � l l <br /> Applicant Permitee Signature Date Issued Qy Signature Datc <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />