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. CITY OF ORONO PERMIT NO.: 2011-00437 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssUED: 06/08/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1699 NORTH FARM RD <br /> PIN : 27-118-23-44-0007 <br /> LEGAL DESC : THE FARM AT LONG LAKE <br /> : LOT 006 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: PIPE SIZE- 1-1/4" MATF RIAL-HDPE SCHEDULE 40 AIR TESTED <br /> OTHER INSPECTION REQURIED-AIR TEST <br /> �� � �� I �v l `3? �i <br /> APPLICANT $EWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> GROTH SEWER& WATER STATE SURCHARGE SEWER&WATER 5.00 <br /> 775 TOWER DRIVE TOTAL 55.00 <br /> HAMEL, MN 55340- <br /> (763)478-6712 <br /> Minnesota State License#: 058606-PM <br /> OWNER <br /> TRUSTEE, RICHARD PERKINS <br /> 1699 NORTH FARM RD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,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 wmpied with whether or not specified hcrein.This permi[will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuancc,or if construction is <br /> suspended for a period of 180 days at any time after work has commenced. <br /> The applicant is res s�'le for assuring all required inspections are <br /> request con� m ce with the State Building Code.This permit may be <br /> revQked at ti for due ca � <br /> � <br /> — � � /-/ �` / �/ U / �� <br /> ; licant er rte � nature Date Issued Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />