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. • CITY OF ORONO * 2 P1 1 4 — 0 PJ 6 Z 9 * <br /> 2750 KELLEY PARKWAY DATE [Ssu�n: 06/18/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2605 KELLY AVE <br /> PIN : 20-117-23-14-0022 <br /> LEGAL DESC : TOWNSITE OF LANGDON PARK <br /> : LOT 005 BLOCK 005 <br /> PERMIT TYPE : SEWER& WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECT[ON <br /> NO"1'G: WA1�ER AND S1�WER CONNF,C'I'ION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BURNS EXCAVA"TWG, INC. <br /> 3470 CO. RD 21 STATE SURCHARGE SEWER& WATER 5.00 <br /> MAYER, MN 55360- TOTAL 105.00 <br /> (612)685-4303 Payment(s) <br /> Minnesota State License#: SW-1888 CREDIT CARD 6518 ]05.00 <br /> OWNER <br /> WINE, SCOTT&JILL <br /> 2587 KELLY AVE <br /> EXCELSIOR, MN 55331- <br /> AGREEMENT AND SWORN STATEMENT <br /> l�he work for which this permit is issued shall be performed accordine to <br /> the approved plans and specitications,applicable Ciry approvals,and the <br /> State I3uilding Code. This permit is for only the work described and does <br /> no[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 N�ith whether or no[specified herein."Chis permit will <br /> expire and become null and void it�construc[ion 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 applicant is responsible for assuring all required inspections are <br /> requested in cont�ormance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �� ��i,2a� � �1�� d <br /> Applicant Pcrmitee Signature Date Issued y Signature Date <br />