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CITY OF ORONOII*II'2II III S - 0 III II I III I I I 111111 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/16/2015 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2350 OLIVER HILL <br /> PIN : 34-118-23-33-0071 <br /> LEGAL DESC : OLIVER HILL <br /> : LOT 1 BLOCK 1 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER CONNECTION TO LONG LAKE PAID 09/23/15#2015-01046 IN THE AMOUNT OF$1,800.00 <br /> SAC PAID 09/23/15#2015-01046 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> FINAL GRADE,INC MAIL-IN FEE 2.00 <br /> 3441 BLUFF DR. <br /> JORDAN,MN 55352 TOTAL 53.00 <br /> (952)492-5100 Payment(s) <br /> Minnesota State License#:BUIL-1442 CREDIT CARD 4703 53.00 <br /> OWNER <br /> PRENEVOST,JEAN&REBECCA <br /> 2020 ARCHER 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 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 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 /2P <br /> revoked at any time for due cause. �/ <br /> /( 0:1 c? V? dSO / D/ l Le/ l S <br /> Applicant Permitee Signature Date Issued By Signature Date <br />