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' ''� CITY OF ORONO * 2 PJ 1 4 - P1 0 2 8 1 * <br /> , 2750 KELLEY PARKWAY DATE ISSUED: 04/07/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4225 FOREST LAKE DR <br /> PIN : 07-117-23-12-0025 <br /> LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN <br /> : LOT 003 BLOCK 003 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR -4"PIPG-SCH 40 AIR"CI:S"I�ED <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> S"t'ATE SURCHARGE SEWER& WATER 5.00 <br /> ROTO ROOTER SERVICES CO. TOTAL 55.00 <br /> 14530 27TH AVE. N. Payment(s) <br /> MINNEAPOLIS, MN 55447- CREDIT CARD 0472 55.00 <br /> (763)519-3907 <br /> OWNER <br /> ANDERSON, KENNETH <br /> 4225 FOREST LAKE DR <br /> MOi1ND, MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> 'I'he work tbr���hich this permit is issued shall be performed accordin�to <br /> the approved plans and specifications,applicable City approvals,and Ihe <br /> State Building Code. This pennit is for only the work described and does <br /> not grant permission for additional or related work which requires separatc <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied wi[h whether or not specified herein.'l�his 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 confonnance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> �� � ���� � � � � /� <br /> Applicant; ermite �ignature Date Iss d By Signature Date <br /> ��. <br />