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s CITY OF ORONO 111111111111 IN 1111111 IN 11111 1111111H <br /> 2750 KELLEY PARKWAY * 20 1S - 00648 <br /> DATE ISSUED: 05/21/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 1000 WILLOW DR S <br /> PIN 10-117-23-21-0004 <br /> LEGAL DESC UNPLATTED 10 117 23 <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE SEPTIC Foy h(J `� �n-6 , (' �/V�PROPERTY TYPE : RESIDENTIAL X V <br /> CONSTRUCTION TYPE : REPAIR W mi-f 4k201+- 0(L46 q <br /> NOTE: REPLACE(2)PLASTIC 1,000 GALLON TANKS PI/n�Nn 11/yyt <br /> APPLICANT SEPTIC REPAIR 100.00 <br /> STATE SURCHARGE SEPTIC 5.00 <br /> SWEDLUND SEPTIC <br /> TOTAL 105.00 <br /> 930 DEER CREEK PARKWAY <br /> MPayment(s) <br /> N 56011- <br /> 952-657-1034 CHECK 1875 105.00 <br /> OWNER <br /> KLOMBIES,LINDSAY&ANNA <br /> 1000 WILLOW DR S <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 d e e. <br /> licant Permitee Signature ate I*ssBy Signature Date <br />