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� � CITY OF ORONO * Z 0 1 2 — 0 fd 5 4 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/15/2012 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 495 OXFORD RD <br /> PIN : OS-117-23-41-0011 <br /> LEGAL DESC : STIELOWS ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> MARK BENDICKSON,INC. STATE SURCHARGE SEWER&WATER 5.00 <br /> 1501 HiJNTER DR TOTAL 55.00 <br /> WAYZATA,MN 55391- <br /> (612)695-8072 <br /> OWNER <br /> SAMPLE,MIKE&ANNE <br /> 1449 BAY RIDGE 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 dces <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.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 respo�sible for assuring all required inspections are <br /> reque d in conf rm with the State Building Code.This permit may be <br /> revok a any ti fo due caus . <br /> / / / / <br /> pplic rmitee S D Issue y � ature te <br /> EPARATE PERMITS REQUIRED FOR WORK OTHE N DESCRIBED ABO <br />