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CITY OF ORONO PERMIT NO.: 2010-00686 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 08/10/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 4025 WATERTOWN RD <br /> PIN 31-118-23-41-0012 <br /> LEGAL DESC UNPLATTED 31 118 23 <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE SEPTIC <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE NEW <br /> ACTIVITY MOUND SYSTEM-SEPTIC <br /> d <br /> APPLICANT SEPTIC NEW 200.00 <br /> INGLESIDE ENGINEERING&CONST STATE SURCHARGE SEPTIC 5.00 <br /> 4920 HIGHWAY 55 <br /> P.O.BOX 127 MISC FEE 0.00 <br /> LORETTO,MN 55357 TOTAL 205.00 <br /> (763)479-1869 <br /> Minnesota State License#: 874 <br /> OWNER <br /> FANDEL,MARY <br /> 4025 WATERTOWN RD <br /> MAPLE PLAIN,MN 55359 <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 w' the State Building Code.This permit may be <br /> revoked at any time r u use. <br /> pplican ennitee Signature Date I d By S a re Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />