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� � CITY OF ORONO <br /> 2750 KELLEY PARKWAY * 2 0 1 6 - 0 0 4 7 8 * <br /> DATE ISSUED: OS/04/2016 <br /> ORONO,MN 55356- <br /> � (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2024 SHADYWOOD RD <br /> PIN : 17-117-23-31-0011 <br /> LEGAL DESC : GUST S JOHNSONS ADDN <br /> : LOT 004 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR <br /> APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> WELD&SONS PLUMBING CO INC. MAIL-IN FEE 2.00 <br /> 3410 KILMER LANE N <br /> PLYMOUTH,MN 55441- TOTAL 53.00 <br /> (763)475-0296 Payment(s) <br /> Minnesota State License#:plbg-PC646375,mech-MB003315 CREDIT CARD 6763 53.00 <br /> OWNER <br /> KIEFFER,JOHN&BENJAMIN <br /> 2024 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 Ciry approvals,and the <br /> State Building Code. 'I'his permit is for only[he work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing 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 wnformance with the State Building Code.This pertnit may be <br /> revoked at any time for due cause. <br /> . <br /> � � / /--� <br /> Applicant Permitee Signature Date Issued Signature Date <br />