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CITY OF ORONO * z 0 1 z - B 0 5 1 z * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/19/2012 <br /> �� ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 350 BROWN RD S <br /> PIN : 03-117-23-13-0001 <br /> LEGAL DESC : UNPLATTED 03 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> NOTE: 3 NORWESCO BRUISER TANKS <br /> SIZE OF TNAKS- 1250- 1250- 1500 <br /> MOUND TREATMENT SYSTEM-620 S.F. <br /> *****INSTALLER TO CALL FOR SOILS VER[FICATION BEFORE START OF MOUND SYSTEM. <br /> APPLICAI�IT SEPTIC NEW 200.00 <br /> KOTHRADE SEWER& WATER STATE SURCHARGE SEPTIC 5.00 <br /> 12059 WHITETAIL AVENUE <br /> HANOVER, MN 55341 MAIL-IN FEE 2.00 <br /> O TOTAL 207.00 <br /> Minnesota State License#: 0192 PAID WITH CC# 4122 <br /> OWNER <br /> CHALFEN,RICHARD <br /> 350 BROWN RD S <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[he date of issuance,or if construction is <br /> suspended for a period of l80 days at any time afrer work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the Sta[e Building Code.This permit may be <br /> revoked at any time f ue e. � <br /> � OL4� �-(�(_ / ��� <br /> , � �/S%./� <br /> A licant Pe itee Si � ture ate �`--'�� �'�722 c.t.yl / / <br /> pp � Issued By S'gnature Date <br /> SEPARATE PERMITS UIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />