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CITY OF ORONO * 2 0 1 5 - 0 0 2 7 6 * <br /> ' 2750 KELLEY PARKWAY DATE ISSUED: 03/09/2015 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4009 NORTH SHORE DR <br /> PIN : 07-117-23-44-0004 <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 DISCONNECT <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 5.00 <br /> KNAPP&SONS SEPTIC TOTAL 55.00 <br /> 13574 110TH STREET Payment(s) <br /> MILACA,MN 56353- CHECK 5543 55.00 <br /> (763)477-8566 <br /> OWNER <br /> LUZICH,PETER&ELIZABETH <br /> 4009 NORTH SHORE DR <br /> MOLTND,MN 55364 <br /> AGREEMENT AND SWORI�T 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. This permit is for only the work described and dces <br /> not grant permission for additional or related work 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 aze <br /> requested in conformance with the State Building Code.This pern►it may be <br /> revoke time for due cause. <br /> :: �,� � � � �-5 <br /> A licant Permitee ' Date Issue y Signature Date <br />