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f � CITY OF ORONO * 2 0 1 4 - 0 1 3 2 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1 Ul3/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1480 SIXTH AVE N <br /> PIN : 26-118-23-32-0008 <br /> LEGAL DESC : DOUGLAS ESTATES <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTNITY : MOUND SYSTEM- SEPTIC <br /> APPLICANT SEPTIC NEW 200.00 <br /> STATE SURCHARGE SEPTIC 5.00 <br /> HAYES& SONS EXC. INC. TOTAL 205.00 <br /> 263 82ND STREET S.E. Payment(s) <br /> MONTROSE, MN 55303- CREDIT CARD 5293 205.00 <br /> (763)479-1762 <br /> Minnesota State License#: sept-L640 <br /> OWNER <br /> GULBRANDSON, DAN& ERICKA <br /> 1480 SIXTH AVE N <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 speciYications,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 oY laws and ordinanccs governing this type of wark <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 are <br /> requested in conlormance with the State Quilding Code.This permit may be <br /> revoked at any time or due causc. <br /> _- <br /> � ' . <br /> "� � � `�� ! i � i/ <br /> Ap icant Permitec-Sig ature Date � Iss e y Signature Date � <br />