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CITY OF ORONO * z 0 1 3 - P1 0 8 4 5 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 08/22/2013 <br /> ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1535 MINNIE AVE <br /> PIN : 08-117-23-33-0065 <br /> LEGAL DESC : HICKORY HILL <br /> : LOT 005 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> " � 2f �� t9Co� <br /> S'!�-e CrPc�c�`" <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> OLSON CONSTRUCTION CO. STATE SURCHARGE SEWER&WATER 5.00 <br /> 6970 INWOOD ROAD <br /> COLOGNE,MN 55322- TOTAL 55.00 <br /> (952)448-6674 PAID WITH CC# 5490 <br /> Minnesota State License#: L1111 <br /> OWNER <br /> Landscource LLC <br /> 550 25TH AVE N <br /> ST CLOUD,MN 56303- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved pians 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 sepazate <br /> permits. All provisions of laws and ordinances goveming 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 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 /> / / / / <br /> Applicant Permitee Signature Date Issue By ' ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A VE. <br />