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111111111111111111111 ffliffm <br /> CITY OF ORONO * 2 0 1 2 — 0 0 4 1 8 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/17/2012 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 1005 WILLOW DR S <br /> PIN 10-117-23-24-0012 <br /> LEGAL DESC UNPLATTED 10 117 23 <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE SEWER <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE REPAIR <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> ROTO ROOTER SERVICES CO. STATE SURCHARGE SEWER&WATER 5.00 <br /> 14530 27TH AVE.N. TOTAL 55.00 <br /> MINNEAPOLIS,MN 55447- <br /> (763)519-3907 PAID WITH CC# 6159 <br /> Minnesota State License#:058341 <br /> OWNER <br /> SPENCER,MARTHA <br /> 1005 WILLOW DR S <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 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 cont rmance with the State Building Code.This permit may be <br /> revoked at any ' e for due c se. /(/✓ <br /> pplicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />