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^ CITY OF ORO�TO * 2 0 1 3 - 0 P1 3 5 7 * <br /> 2750 KELLEY PARI�WAY DATE ISSUED: 05/14/2013 <br /> '� ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 495 OXFORD RD <br /> pIN : OS-117-23-41-0011 <br /> LEGAL DESC : STIELOWS ADDN <br /> : LOT 003 BLOGK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> D.S.M.EXCAVATING STATE SURCHARGE SEWER&WATER 5.00 <br /> 2916 ENTERPRISE AVE <br /> HASTINGS,MN 55033- TOTAL 55.00 <br /> (651)480-1355 PAID WITH CC# 0444 <br /> OWNER <br /> SAMPLE,MIKE&ANNE <br /> 1449 BAY RIDGE RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this perntit is issued sha11 be perforn►ed acwrding 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 gant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinaz►ces 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 are <br /> requested in confo ce with the e Building Code.This permit may be <br /> revoked at y ti or au . <br /> ' � /y � .13 � <br /> A lic t Permitee Signatur Date Issued By Si re a e <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO <br />