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/ � <br /> CITY OF ORONO * Z 0 1 5 - 0 0 6 0 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/15/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2705 SHADYWOOD RD <br /> PIN : 21-117-23-24-0003 <br /> LEGAL DESC : PHEASANT LAWN <br /> : LOT 025 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 5.00 <br /> WESTONKA SEWER&WATER TOTAL 55.00 <br /> 6501 CO.RD I S Payment(s) <br /> MOLJND,MN 55364 CREDIT CARD 8752 55.00 <br /> (952)472-4959 <br /> Minnesota State License#:BUIL-1804 <br /> OWNER <br /> NEWRAI, SOHRAB&NLIE <br /> 2705 SHADYWOOD RD <br /> EXCELSIOR,MN 55331- <br /> AGREEMENT AND SWORN STATEMENT <br /> 1'he 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 dces <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 hereia This permit will <br /> expire and become null and void if construction suthorized 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 any time for due cause. <br /> ���. � ' �/�J /N <br /> Applicant Permitee Signature Date Issued Signature Date <br />