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4 CITY OF ORONO * Z 0 1 6 - 0 0 4 3 2 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 04/26/2016 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1495 GREEN TREES RD <br /> PIN : 11-117-23-23-0012 <br /> LEGAL DESC : GREEN TREES ON TANAGER LAKE <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCT[ON TYPE : CONNECTION <br /> N07'E: SAC PAID#4425 02/18/91 <br /> APPL[CANT SEWERCONNECT/DISCONNECT/REPA[R 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> PATNODE BROTHERS INC. MAIL-IN FEE 2.00 <br /> 2841 LANDER AVE <br /> ST. MICHEAL,MN 55376- TOTAL 53.00 <br /> (612)919-0112 Payment(s) <br /> Minnesota State License#: sept-L3843 CHECK 3350 53.00 <br /> OWNER <br /> BRASS, JAMES&JUDITH <br /> 1495 GREEN TREES 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 the <br /> State Building Code. This permit is for only the work described and does <br /> not 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 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 l80 days at any time after work has commenced. <br /> The appiicant 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. � �T��) <br /> � �\L`� � '� ��.�..�t ���1.1 / <br /> � � i � z�. ' <br /> ` U� z �- � <br /> Applicant Permitee Signature � Date� Issued By Signatur� Date <br />