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CITY OF ORONO * z 0 1 5 - 0 1 z 6 7 * <br /> " 2750 KELLEY PARKWAY DATE ISSUED: 09/30/2015 <br /> ' ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2927 FARVIEW LA <br /> PIN : 04-117-23-34-0410 <br /> LEGAL DESC : FARVIEW <br /> : LOT O10 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTIOI�1 TYPE : CONNECTION <br /> NOTE: SEWER CONNECTION-4"PIPE SCHD 40 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER& WATER 1.00 <br /> BURNS EXCAVATING, INC. <br /> 3470 CO. RD 21 TOTAL 51.00 <br /> MAYER,MN 55360- Payment(s) <br /> (612)685-4303 CHECK 26770 51.00 <br /> Minnesota State License#: SW-1888 <br /> OWNER <br /> SACHSE, RICHARD& MARYLYNNE <br /> 2927 FARVIEW LA <br /> LONG LAKE,MN 55356- <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 rela[ed work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shali 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 /> reques[ed in c formance with the State Building Code.This permit may be • <br /> revoked at time for due�ause. / <br /> ---- ; , �� � <br /> _-- <br /> /�'%' i . '�, � ,� ��i�0'�`'� � �Q _ f--� � �S� � , �� ,/� <br /> Applica tq� Pe itee ignatur Date [ssued y�ig iature Date <br /> �� ��. <br />