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' ` CITY OF ORONO * 2 0 1 5 — 0 1 0 6 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 08/2U2015 <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 : CONNECTION <br /> NOTE: SEWER CONNECTION-4"PIPE-SCH 40 <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> STATE SURCHARGE SEWER&WATER 1.00 <br /> KNAPP&SONS SEPTIC TOTAL 51.00 <br /> 13574 110TH STREET <br /> MILACA,MN 56353- Payment(s) <br /> CREDIT CARD 5662 51.00 <br /> (763)477-8566 <br /> Minnesota State License#: sept-PB644309 <br /> OWNER <br /> Craig Scherber&Associates, Inc. <br /> 305 LAKEVIEW DR <br /> TONKA BAY,MN 55331- <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 re(ated work which requires sepuate <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 l80 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 State Building Code.This permit may be <br /> revoked at any time for due cause. ) <br /> / <br /> , � z;; �' / o Z/ / /S <br /> Applicant Permitee Signature Date Issue y Signature Date <br />