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'� ' CITY OF ORONO * z 0 1 3 — fd 0 7 4 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/3U2013 r <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1421 NORTH ARM DR <br /> PIN : 07-117-23-44-0073 <br /> LEGAL DESC : HIGHWOOD LAKE MTKA <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER DISCONNECTION <br /> SEWER-4"PIPE-SCHEDULE 40 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> KNAPP& SONS SEPTIC STATE SURCHARGE SEWER&WATER 5.00 <br /> 13574 110TH STREET <br /> MILACA,MN 56353- MAIL-IN FEE 2.00 <br /> (763)477-8566 TOTAL 57.00 <br /> PAID WITH CC# 3168 <br /> OWNER <br /> NORMAN,THOMAS <br /> 1421 NORTH ARM DR <br /> MOUND,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 onty the work described and does <br /> not grant permission for additional or related wark which requires sepazate <br /> permits. 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 responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoJced at any time for due ca se. <br /> � , j �, � ��l� <br /> p ican Permitee Sig ure Date ssu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />