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CITY OF ORONO PERMIT 1Y0.: 2011-00465 <br /> 2750 KELLEY PARKWAY <br /> . ORONO, MN 55356- �ATE ISsuED: 06/14/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1729 NORTH FARM RD <br /> PIN : 27-118-23-44-0018 <br /> LEGAL DESC : THE FARM AT LONG LAKE <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : SEWER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : CONNECTION <br /> NOTE: PER E-MAIL DATED 10/19/2010 BETWEEN MIKE GAFFRON&KARON CAPPAERT AT MET COUNCIL NO SAC <br /> SAC CHARGE OF$425.00 WAS PAID IN 1983 <br /> E-1 PUMP <br /> SEWER CONNECTION-PIPE S[ZE- 1-1/4" SCHEDULE 40 AIR TESTED-MATER[AL-HDPE <br /> APPLICANT <br /> SEWER 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 /> FIELD,MR. & MRS. BENJAMIN <br /> 1729 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 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 re nsible for assuring all required inspections are <br /> requested in c or ance with the State Building Code.This permit may be ,�" <br /> o e t y ' e for due ca e. r <br /> � <br /> , , , ; � ' C, , , , � <br /> Applicant Pe mitee Si ture Date Issu�� By Signature � Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />