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CITY OF ORONO * Z 0 1 3 - 0 1 1 9 7 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 1U12/2013 <br /> ` ORONO, MN 55356- <br /> � (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1105 FERNDALE RD W <br /> PIN . 02-117-23-43-0033 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0441 <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : RE-CONNECT <br /> • / <br /> ` <br /> � <br /> ` <br /> � <br /> � <br /> ` <br /> ` <br /> APPWCANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> DELSON PLUMBING, INC. STA SURCHARGE SEWER& WATER 5.00 <br /> 1308 42 1/2 AVE.NE <br /> MINNEAPOLIS, MN 55421- TOTAL 55.00 <br /> �� PAID WITH CC# 0876 <br /> Minnesota State License#: PC000954 <br /> OWNER <br /> TRUWIT, CHIP <br /> 1105 FERNDALE RD W <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN S TEMENT <br /> The work for which this permit is issued shall be erformed according to <br /> the approved plans and specifications,applica City approvals,and the <br /> State Building Code. This permit is for only e work described and does <br /> not gran[permission for additional or rela work which requires separate <br /> permits. All provisions of laws and ordi nces goveming this type of work <br /> shall be compied with whether or not � ecified herein.This permit will <br /> expire and become null�nd void if nstruction authorized is not <br /> commenced withiry 180 days of t date of issuance,or if construction is <br /> suspended for a period of,k8a day;�Q any time after work has commenced. <br /> The applicant is responstble fqr'a�su 1�all required inspections are <br /> requested in ebnformance�y,ithQhe�tate Building Code.This permit may be <br /> revo ed at any time t d�craus�C. <br /> , <br /> ' �r i /,1 i %� i i <br /> Applicant Permitee Sig ture � Date Issued Bv Si ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE. <br />