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, � CITY OF ORONO PERMIT NO.: 2010-01071 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 1U0U2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1980 SIXTH AVE N <br /> PIN : 27-118-23-42-0004 <br /> LEGAL DESC : UNPLATTED 27 1 18 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : REPAIR <br /> M�-�-,�ti� <br /> APPLICANT SEPTIC REPAIR 100.00 <br /> INGLESIDE ENGINEERING&CONST STATE SURCHARGE SEPTIC 5.00 <br /> 4920 HtGHWAY 55 <br /> P.O. BOX 127 TOTAL 105.00 <br /> LORETTO, MN 55357 <br /> (763)479-1869 <br /> Minnesota State License#: 874 <br /> OWNER <br /> PIERPONT,JUDY&JIM <br /> 1980 SIXTH AVE N <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> 'I'he work for which this permit is issued shall be performed according to <br /> the approved plans and specitications,applicable City approvals,and thc <br /> State Building Code. This permit is for oniy the work described and does <br /> not gran[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 whe[her 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 l80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��, <br /> � �'� � � � ��r //� D/� /1J <br /> Applicant Permitee Signature Date ssued Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />