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� � � �' CITY OF ORONO * z Q� 1 5 - 0 0 6 8 1 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: OS/29/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDR�SS : 945 FOREST ARMS LA <br /> PIN : 07-117-23-12-0019 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 000 BLOCK 002 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION <br /> APPL[CANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> CHUCK'S EXCAVATING STATE SURCHARGE SEWER& WATER 5.00 <br /> 760 WEST 96TH STREET TOTAL 55.00 <br /> CHANHASSEN, MN 55317- Payment(s) <br /> (952)496-2874 CHECK 5262 55.00 <br /> Minnesota State License#: SW-L3320 <br /> OWNER <br /> EATON, BOB&JENNIFER <br /> 2721 COMSTOCK LA N <br /> PLYMOUTH, MN 55447- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which[his 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 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 aze <br /> requested in conformance with[he State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � � � S ^ �� -ls- 5 , 2�, � <br /> ���� � <br /> Applicant Permitee Signature Date Issued Signature Date <br />