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CITY OF ORONO PERMIT NO.: 2009-00428 <br /> t` 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 07/30/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS 1165 WYNDMERE RD <br /> PIN 26-118-23-41-0010 <br /> LEGAL DESC WYNDMERE <br /> LOT 004 BLOCK 001 <br /> PERMIT TYPE SEPTIC <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE NEW <br /> ACTIVITY OTHER-SEPTIC <br /> NOTE: PRESSURE BED SYSTEM <br /> APPLICANT SEPTIC NEW 200.00 <br /> KOTHRADE SEWER&WATER STATE SURCHARGE SEPTIC 0.50 <br /> 12059 WHITETAIL AVENUE TOTAL 200.50 <br /> HANOVER,MN 55341 <br /> Minnesota State License#:0192 <br /> OWNER <br /> HONG,BACK <br /> 1165 WYNDMERE 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. <br /> Applicant Permitee Signature Date Issued By Onature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AAOVE. <br />