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-� CITY OF ORONO <br /> ` 2750 KELLEY PARKWAY * 2 0 1 3 - 0 0 9 1 B * <br /> DATE ISSUED: 09/09/2013 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: 952)249-4616 <br /> ADDRESS : 4395 NORTH SHORE DR <br /> PIN : 07-117-23-43-0018 <br /> LEGAL DESC : SAGA HILL REVISED <br /> : LOT 000 BLOCK 018 <br /> PERMTT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: SEWER CONNECTION-4'PIPE-MATERIAL-SCHEDULE 40 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> ABLE EXCAVATING STATE SURCHARGE SEWER&WATER 5.00 <br /> 15630 OLD BRICK YARD RD. <br /> SHAKOPEE,MN 55379 MAIL-IN FEE 2.00 <br /> (952)445-7432 TOTAL 57.00 <br /> Minnesota State License#:077992-RP PAID WITH CC# 9988 <br /> OWNER <br /> CORNESS,JOHN&BARBARA <br /> 4395 NORTH SHORE DR <br /> MOLJND,MN 55364 <br /> AGREEMENT AND SWORN STATEMENT <br /> T'he 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 Bui(ding Code. 1'his permit is for only the work described and does <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.l'his 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 asswing all required inspections are <br /> requested in conformance with the State Building Code.T'his permit may be <br /> revoked at y time for due cause. <br /> / / / / <br /> Applic t Pe itee ignature Date Issued y ature <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . <br />