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CITY OF ORONO * Z QJ 1 2 — 0 0 1 4 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 30 MYRTLEWOOD RD <br /> PIN : 36-118-23-33-OOl 1 <br /> LEGAL DESC : MYRTLEWOOD <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NO"I'1',: WATER CONNEC"I'ION-PIPE SIlE; 1" -SCHEDUI_,E 40 <br /> APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> MUSKA PLUMBING STATE SURCHARGE SEWER&WATER 5.00 <br /> 1985 OAKCREST AVE <br /> ROSEVILLE, MN 55113- TOTAL 55.00 <br /> (651)286-0056 PAID WITH CC# �+10 <br /> Minnesota State License#: 60919-PM C�J�'�� <br /> OWNER <br /> PAULSON, BRUCE& LORI <br /> 30 MYRTLEWOOD RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> 'I'hc 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 specitied 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 fo due cause. <br /> �, / �,7�./'�.O`2 �% a'�`-/ / <br /> A licant Per itee Signature Date Issue y Signaturc Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OT ER THAN DESCRIBED ABOVE. <br />