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-� <br /> _ CITY OF ORONO * z 0 1 7 - 0 0 1 0 7 * <br /> " 2750 KELLEY PARKWAY DATE ISSUED: 02/07/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 669 MINNETONKA HGLD LA <br /> Pllv : 06-117-23-44-0007 <br /> LEGAL DESC : MINNETONKA HIGHLANDS ESTATES <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> COI�ISTRUCTIOPT TYPE : DISCONNECTION <br /> NOTE: SAC PAID#2819- 1973. <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> A.L. SHERMER CONST. 1NC. TOTAL 51.00 <br /> 13451 BALSAM LANE N <br /> DAYTON, MN 55327- Payment(s) <br /> (763)286-0121 CHECK 6813 51.00 <br /> Minnesota State License#: SW-PB634960 <br /> OWNER <br /> SHIELDS, MICHAEL&MELISSA <br /> 800 LANEWOOD LANE N <br /> PLYMOUTH,MN 55447- <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 Ciry 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 ifconstruction 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 inspections are <br /> requested in conformance with[he State Building Code.This permit may be <br /> revoked at any time for dt�cause. <br /> i <br /> / ' <br /> '�' :�.✓..,�� .� � � � � � r �� <br /> . / ,r � , . <br /> /� - L � . <br /> � �.-�1!,�`/i�-�._ � � �� c� c��_.,, E, _�c ��. -�- � �7 � / � <br /> Applicant ermitee Signature Date Issued By Signature Date <br />