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CITY OF ORONO PERMIT NO.: 2011-01377 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 11/03/2011 <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4490 WATERTOWN RD <br /> PIN : 31-118-23-21-0005 <br /> LEGAL DESC : N/A <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> NOTE: REUSE(1)PRECASTE CONCRETE TANK <br /> (2)DARWIN- 1,000 GALLON TANKS <br /> 1,000 GALLON LIFT <br /> MOUND TREATMENT SYSTEM-380 S.F.-10 X 38 <br /> APPLICANT SEPTIC NEW 200.00 <br /> HAYES&SONS EXC.INC. STATE SURCHARGE SEPTIC 5.00 <br /> 263 82ND STREET S.E. TOTAL 205.00 <br /> MONTROSE,MN 55303- <br /> (763)479-1762 PAID WITH CC# 5293 <br /> Minnesota State License#: 640 <br /> OWNER <br /> CHELBERG,GLEN&MICHAELA <br /> 4490 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 /> requeste s ' confo •ance with the State Building Code.This permit may be <br /> �evoke1.f t any ti . or. e cause. <br /> l / /// ti <br /> Applicant Pe . Signature Date Issue 11By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />