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I DI II III IIIIII 11111111 1 I11 II <br /> CITY OF ORONO * 20 1 5 - 0 1 2 2 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/30/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 2790 WHITE OAK CIR <br /> PIN : 04-117-23-42-0016 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1447 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW OR REPLACEMENT(SEPTIC SYSTEM) <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> NOTE: (3)PRECAST CONCRETE TANKS <br /> (2) 1300 GALLON <br /> (1) 1000 GALLON <br /> MOUND-500 S.F. <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> HAYES&SONS EXC. INC. TOTAL 400.00 <br /> Payment(s) <br /> 263 82ND STREET S.E. CREDIT CARD 5293 400.00 <br /> MONTROSE,MN 55303- <br /> (763)479-1762 <br /> Minnesota State License#: sept-L640 <br /> OWNER <br /> DOHERTY,MR.&MRS. <br /> 2790 WHITE OAK CIR <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 he <br /> srvoeketrat . e for due cause. 1 7 <br /> Applicant Permfature Date Issued By Signature Date <br />