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CITY OF ORONO PERMIT NO.: 2009-00921 <br /> �- 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE tss�En: 12/3U2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> REPRINTED ON 12/31/2009 <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 : SEWER <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : PASS�'OUfa�I'F'EES GJ�/�,y�Q�G�'�1� <br /> NOTE: THIS IS THE SEWER&SAC CONNGCTION FEE FOR PL;RM["C#2009-00923 <br /> PAID VIA: STEVEN CHAMPLIN,OWNER <br /> APPLICANT SEWER CONNECTION CHARGE- WAYZATA 525.00 <br /> CHAMPLIN, MR.& MRS. S.A.C. 2,000.00 <br /> 50 MYRTLEWOOD RD <br /> WAYZATA, MN 55391- TOTAL 2,525.00 <br /> OWNER <br /> CHAMPLIN, MR.&MRS. <br /> 50 MYRTLEWOOD RD <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> 7he work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and dic <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 goveming this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become nuli 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 atter 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 bc <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 />