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� ' CITY OF ORONO PERMIT NO.: 2oiaoo9�o <br /> � •T'' 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuED: 10/18/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2056 SHORELINE DR <br /> PIN : 15-117-23-21-0002 <br /> LEGAL DESC : HARTWOOD <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> NOTE: (1)PRECAST CONCRETE TANK- 1,000 GALLON-MOUND SYSTEM-380 S.F. <br /> APPLICANT SEPTIC NEW 200.00 <br /> BURSCH BROTHERS INC. STATE SURCHARGE SEPTIC 5.00 <br /> P.O.BOX 55 TOTAL 205.00 <br /> HANOVER,MN 55341 <br /> (612)221-1493 <br /> Minnesota State License#: 2727 <br /> OWNER <br /> PATTY SILVA,MICKEY MAUDE <br /> 2056 SHORELINE DR <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 does <br /> not grant permission for additional or related work which requires separate <br /> permiu. 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 responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ���.1�-�_� (o/ �� / (� /l�/ / /!� <br /> Applicant Permitee Signature Date Iss By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />