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CITY OF ORONO * z 0 1 7 - 0 0 3 2 8 � <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/06/2017 <br /> . . ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1122 LOMA LINDA AVE <br /> PIIY : 08-117-23-23-0026 <br /> LEGAL DESC : LOMA LINDA <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SAC PA[D#2016-01015 - 10/18/16 <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> COPPIN SEWER&WATER <br /> 864 QUAIL PKWY TOTAL S1.00 <br /> WATERTOWN,MN 55388- Payment(s) <br /> CREDIT CARD 6381 51.00 <br /> (612)508-9974 <br /> Minnesota State License#: SW-57329MR <br /> OWNER <br /> BERGH, HANS&SHARON <br /> 905 WILLOW VIEW DR <br /> LONG LAKE, MN 55356- <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 l80 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 inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> — ��-�J <br /> 1 , <br /> ��� L� L��--� '1 ��� � � �'� L/ j/ � !' / /_ <br /> �,(:��,...r�. � ? <br /> Applicant Permitee Signature Date Issued By Signature Date <br />