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CITY OF ORONO * Z 0 1 6 - 0 1 4 0 7 * <br /> `� 2750 KELLEY PARKWAY DATE ISSUED: il/07/2016 <br /> � ORONO,MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1835 SHADYWOOD RD <br /> PIN : 17-117-23-24-0006 <br /> LEGAL DESC : REG.LAND SURVEY NO.0624 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR ONLY <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> TUMA CONSTRUCTION TOTAL 51.00 <br /> 5045 COiJNTY ROAD 19 Payment(s) <br /> MINNETRISTA,MN 55359- CHECK 4739 51.00 <br /> (763)479-2982 <br /> Minnesota State License#: BUIL-PB695614 <br /> OWNER <br /> HUTTON,MR.&MRS. SCOTT <br /> 1835 SHADYWOOD RD <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. A(I provisions of laws and ordinances goveming this type of work <br /> shall be compicd with whether or not specified herein.This permit will <br /> expire and become null and void if co orized is not <br /> commenced wit 180 day e date of' ce,or i eonstruction is <br /> suspended fo eriod of O.days at an jrfie after work has commenced. <br /> The applic t' respo bl�•�or assur' g�ll required inspections are <br /> requeste n nfo c�with the fe Building Code.This permit may be I <br /> revoke at y ti fo due caus �r� � � <br /> c� <br /> � � Y <br /> � �i � <br /> Applicant Permitee Sig re Date Issued By Signature Date <br />