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CITY OF ORONO PERMIT NO.: 2010-00374 <br /> � , 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE ISSUEu: 05/26/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 550 EAST LONG LAKE RD <br /> PIN : 35-118-23-14-0002 <br /> LEGAL DESC : UNPLATTED 35 1 18 23 <br /> : LOT 000 BC,OCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC YAID$2100.00 CK FROM DAVID NETJES <br /> SEWER CONNECTION FEG PAID$16,790.00 BY DAVID NETJES <br /> SEWER CONNECTION PERMI"I'FEF, PD. $52.50 BY BURNS EXCAVATING <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BURNS EXCAVATING, INC. <br /> 3470 CO. RD 21 STATE SURCHARGE SEWER& WATER 0.50 <br /> MAYER, MN 55360- S.A.C. Qd by Da.0�d IUe�G.s 2,100.00 <br /> �� MAIL-IN FEE 2.00 <br /> Minnesota State License#: 1888 TOTAL 2,152.50 <br /> OWNER <br /> NETJES, DAVID <br /> 550 EAST LONG LAKE RD <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 [he <br /> State Building Code. This permi[is for only the work described and does <br /> not grant permission for additional or related work which requires separa[e <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specitied 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 inspec[ions are <br /> requested in conformance wi[h the State E3uilding Code.This permit may be <br /> revoked at any time for�ue cause. <br /> `��u( !�. / / �R�y��� / / <br /> Applicant Permitee Signature Date Issued Bv ignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. <br />� <br />