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CITY OF ORONO * 2017 - 00662 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/23/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: 952 249-4616 <br /> ADDRESS 120 TRUFFULA TR <br /> PIN 33-118-23-44-0037 <br /> LEGAL DESC MEADOW WOOD POND <br /> LOT 003 BLOCK 001 <br /> PERMIT TYPE SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> NOTE: SEPTIC REPAIR <br /> APPLICANT SEPTIC REPAIR 100.00 <br /> ELMER J. PETERSON COMPANY TOTAL 100.00 <br /> Payment(s) <br /> 5921 DAGUE AVE SE <br /> DELANO,MN 55328 CHECK 20529 100.00 <br /> (763)972-2420 <br /> Minnesota State License#:BUIL-219 <br /> OWNER <br /> DUFAULT,FREDERICK&TRACY <br /> 120 TRUFFULA TR <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 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 /> 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 responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revok ata time for due cause. <br /> LC-� (--::, 013 <br /> oFAjFp?rc—ant Permitee Signature Date Issued By ature Date <br />