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• � � � CITY OF ORONO * 2 0 1 7 - a 0 8 s 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/24/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: 952)249-4616 <br /> ADDRESS : 4105 HIGHWOOD RD <br /> PIN : 07-117-23-44-0014 <br /> LEGAL DESC : HIGHWOOD LAKE MTKA <br /> : LOT 016 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION. � <br /> APPLICANT SEWERCONNECT!DISCONNFC'T'RFP,�IR �n nn <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> D.S.M. EXCAVATING TOTAL 51.00 <br /> 2916 ENTERPRISE AVE <br /> HASTINGS,MN 55033- Payment(s) <br /> (651)480-1355 CREDIT CARD 5166 51.00 <br /> OWNER <br /> PETERSON,JASON <br /> 4105 HIGHWOOD RD <br /> MOLJND,MN 55364 . <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be perfortned according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. 7'his 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 rype 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 are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � ���� �� i i <br /> Applicant Permitee Signature / Date Issued B ignature Date <br />