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CITY OF ORONO j1j11I1111 111I 11II2750 KELLEY PARKWAY <br /> DATE ISSUED: 05/17/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1380 ORONO LA <br /> PIN : 02-117-23-34-0012 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1350 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECT ONLY <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> COPPIN SEWER&WATER STATE SURCHARGE SEWER&WATER 1.00 <br /> 8F4 QUAIL PKWY TOTAL 51.00 <br /> WATERTOWN,MN 55388- Payment(s) <br /> (512)508-9974 CHECK 4900 51.00 <br /> Minnesota State License#: SW-57329MR <br /> OWNER <br /> BELTNICK,LUKE&ELENA <br /> 3018 EMERSON AVE S <br /> MINNEAPOLIS,MN 55408- <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 <br /> revoked at.ny time for due cause. r�j <br /> Roy, <br /> Applicanermitee .igna Date Issued By Signature Date <br />