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, w <br /> l � <br /> CITY OF ORONO * 2 P� 1 7 - 0 1 6 0 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/06/2017 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1720 SHADYWOOD RD <br /> PIN : 17-117-23-21-0019 <br /> LEGAL DESC : SHADY WOOD <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEWER&WATER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : DISCONNECTION <br /> NOTE: SEWER&WATER DISCONNECT <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> WATER CONNECT/DISCONNECT/REPAIR 50.00 <br /> BOLLIG&SONS,INC. STATE SURCHARGE SEWER&WATER 1.00 <br /> 11401 COLJNTY ROAD 3 <br /> HOPKINS,MN 55343- TOTAL 101.00 <br /> (952)938-4133 Payment(s) <br /> CREDIT CARD 9081 101.00 <br /> OWNER <br /> HANSBERGER,TRAVIS <br /> 651 LEXIE CT <br /> EAGAN,MN 55123- <br /> AGREEMENT AND SWORN STATEMENT . <br /> The work for which this permit is issued shall be perfortned according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Building Code. This pertnit is for only the work described and does <br /> not gant permission for additional or related work which requires separate <br /> pertnits. 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 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 assuri I required inspections are <br /> requested in confprmance with the re Building .This permit may be <br /> revoked at a�y;,tlme for due caus ./ <br /> .-��� � <br /> � /� <br /> -/�� �...- (2�� —/ �� / l.(� /� <br /> Applicant Permitee Signature Date Issue y Signature Date <br />