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, , CITYOFORO O * Zp� 15 - 01033 * <br /> 2750 KELLEY PAR WAY DATE ISSUED: 08/27/2015 <br /> ORONO, MN 553 6- <br /> 952 249-4600 FAX: 95 249-4616 <br /> ADDRESS : 4355 BAYSIDE RD <br /> P[N : 06-117-23-12-0007 <br /> LEGAL DESC : UNPLATTED 06 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL � <br /> CONSTRUCTION TYPE : NEW OR REPLACEMENT(SEPTIC $YS EM) <br /> ACTIVITY : MOUND SYSTEM -SEPTIC <br /> NOTE: RE-USING(3)PRECAST CONCRETE TANKS I <br /> i,000 i,000 z,000 ��son2so sPr.iT� � <br /> MOUND-500 S.F. � <br /> APPLICANT SEPT[C NE OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> HAYES& SONS EXC. INC. Payment(s) <br /> 263 82ND STREET S.E. CREDI'�CA 5293 400.00 <br /> MONTROSE,MN 55303- � <br /> (763)479-1762 � <br /> Minnesota State License#: sept-L640 � <br /> OWNER � <br /> WHITE,GREG& LYNN <br /> 4355 BAYSIDE 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 goveming 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 S[ate Building Code.This permit may be <br /> revoked at any time for due cause. <br /> -�� �� ,a�,�� <br /> Applicant Permitee Signature Date I Sig ature Date <br /> I� I <br />