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CITY OF ORONO PERMIT NO.: 2009-00262 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 06/01/2009 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 325 HOLLANDER RD <br /> PIN : 25-118-23-43-0024 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1281 �t�/ <br /> : LOT 000 BLOCK 000 3:3'S Di <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> 1000 <br /> ._/ili 12-.9-7 <br /> APPLICANT SEPTIC NEW 200.00 <br /> PA BROS STATE SURCHARGE SEPTIC 0.50 <br /> 2320000 109 109TH AVE TOTAL 200.50 <br /> ROGERS,MN 55374 <br /> (763)428-7393 <br /> Minnesota State License#: 95 <br /> OWNER <br /> GOLINVAUX,MR.&MRS. <br /> 325 HOLLANDER RD <br /> WAYZATA,MN 55391 <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 /> revoked at any time for due cause. a <br /> / / LY l ( <br /> c�rZ i�'I�'C / / <br /> Applicant Permitee Signature Date Issued By Signatu a Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />