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CITY OF ORONO * z 0 1 z - 0 1 a 2 1 * <br /> � 2750 KELLEY PARKWAY DATE ISSUEll: 10/15/2012 <br /> ' ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS ' : 4495 BAYSIDE RD <br /> PIN : 06-117-23-21-0004 <br /> LECAL DESC : UNPLATTED 06 1 17 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPT[C <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM - SEPTIC <br /> NOTE: MOUND 630 SQ.FT. <br /> ADDING PRECAST CONCRE"1'E TANKS: 500 SEPTIC/1300 LIFT <br /> SIZE OF EXISTING TANKS: 1000/1000(ADD 500)/ 1300 LIFT <br /> SOILS VERIFICATION F3Y TEST PIT MUST BE DONE BEFORE INSTALL. (INITIAL) <br /> APPLICANT SEPTIC NEW 200.00 <br /> HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 5.00 <br /> 263 82ND STREET S.E. TOTAL 205.00 <br /> MONTROSE, MN 55303- <br /> (763)479-1762 PAID WITH CC# 5293 <br /> Minnesota State License#: L640 <br /> OWNER <br /> Katherine Taylor Homes, Inc. <br /> > <br /> AGREEMENT AND SWORN STATEMENT <br /> "I'he work for which this permit is issued shall be perCormed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State F3uilding 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 /> suspcnded 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 /> rcques[ed in conformance with the State Building Code.This permit may be <br /> ,... _ • <br /> [eaceke�i at any tim for due - ��.lf � <br /> ' i� �;� / ��z � j z �t � �Yy� (� � /C � <br /> Ap icant er it Signature Date ` � � C i / �� (J `�`"" <br /> Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED ABOVE. <br />