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. CITY OF ORONO * 2 0 1 3 - 0 0 5 9 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/0]/2013 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1065 FERNDALE RD W <br /> PIN : 02-117-23-43-0021 <br /> LEGAL DESC : REG.LAND SURVEY NO. 1372 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: REPAIR-PIPE 4"PVC <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> MATTS PLUMBING SOLUTIONS STATE SURCHARGE SEWER&WATER 5.00 <br /> 5565 164TH AVE NW <br /> RAMSEY,MN 55303- MAIL-IN FEE 2.00 <br /> (651)341-5899 TOTAL 57.00 <br /> Minnesota State License#: 068021-PM PAID WITH CC# 8789 <br /> OWNER <br /> TRUSTEE,JANE NELSON <br /> 1065 FERNDALE RD W <br /> WAYZATA,MN 55391 <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 separate <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 Stat�Building Code.This permit may be <br /> revoked at any time for due c,�use. <br /> �/h`� � � / / <br /> Applicant Permitee Signature Date Issue By ature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHE HAN DESCRIBED A O <br />