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CITY OF ORONO * 2 PJ 1 2 - P1 1 P1 3 6 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 10/16/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1105 FERNDALE RD W <br /> PIN : 02-117-23-43-0033 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0441 <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : D[SCONNECTION <br /> APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 <br /> OUVERSON SEWER& WATER <br /> P O BOX 247 STATE SURCHARGE SEWER& WATER 5.00 <br /> LORETTO, MN 55357- TOTAL 55.00 <br /> Minnesota State License#t: MR86668 <br /> OWNER <br /> TRUWIT, CHIP <br /> 1105 FERNDALE RD W <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pern�it is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> Sta[e Building Code. This permit is for only the work described and does <br /> not grant permission for additional or rela[ed 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 specitied herein.This permi[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 Cor a period of 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring ali required inspections are <br /> reques[ed in co rmance with the State Building Code.This permit may be <br /> revok y time for due cause. <br /> / / / / <br /> r plica rmitee Signature Date Issucd By ' nature Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED AB <br />