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�, CITY OF ORONO PERMIT NO.: 2011-01454 <br /> -f � 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 1U2U2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4195 HIGHWOOD RD <br /> PIN : 07-117-23-44-0022 <br /> LEGAL DESC : HIGHWOOD LAKE MTKA <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR-4"PIPE SCHEDULE 40 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> OVERSON SEWER&WATER STATE SURCHARGE SEWER&WATER 5.00 <br /> P O BOX 247 MISC FEE 0.00 <br /> LORETTO,MN 55357- <br /> TOTAL 55.00 <br /> OWNER <br /> SMITH,DOUGLAS&ROBAN <br /> 4195 HIGHWOOD RD. <br /> MOLTND,MN 55364 <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 related work which requires sepazate <br /> permiu. 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 res nsible for assuring all required inspections aze <br /> requested in con m9nce with the State Building Code.This permit may be <br /> revoked a �me f r due cause. <br /> ` / / f`/ � / <br /> Applic t er tee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />