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CITY OF ORONO PERMIT NO.: 2oiaooi2o <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 03/03/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 50 MYRTLEWOOD RD <br /> PIN : 36-118-23-33-0006 <br /> LEGAL DESC : REG. LAND SURVEY NO.0446 . <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : PASS THROUGH FEES <br /> NOTE: THIS IS FOR ADDTIONAL$100 FEE FOR PASS THRU TO WAYZATA FOR NEW 2010 RATE. ORIGINAL PERMIT 2009-00922 <br /> WAS ISSUED IN 2009 BUT THE PROJECT WASN'T COMPLETED UNTIL 2010. <br /> APPLICANT WATER CONNECTION CHARGE-WAYZATA 100.00 <br /> CHAMPLIN,MR.&MRS. TOTAL 100.00 <br /> 50 MYRTLEWOOD RD <br /> WAYZATA,MN 55391- <br /> OWNER <br /> CHAMPLIN,MR.&MRS. <br /> 50 MYRTLEWOOD RD <br /> WAYZATA,MN 55391- <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 dces <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 aze <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 Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />