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CITY OF ORONO PERMIT NO.: 2oiaoosa6 <br /> ' � 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 07/OU2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1610 SHADYWOOD RD <br /> PIN : 17-117-23-21-0010 <br /> LEGAL DESC : SHADY-WOOD <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEWER REPAIR <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> PIPELINE IND STATE SURCHARGE SEWER&WATER 5.00 <br /> 2270 CAPP RD <br /> SAINT PAUL,MN 55108- TOTAL 55.00 <br /> (651)645-0622 <br /> OWNER <br /> ROGERS,D&G <br /> 1610 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 sepazate <br /> permits. All provisions of laws and ordinances governing 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 conswction 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked time for du <br /> '�l i l 20� 'y l / l 1 C) <br /> Applicant Permitee Sig Date Iss By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />