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• , CITY OF ORONO * 2 0 1 5 - 0 1 3 3 0 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 10/16/2015 <br /> ORONO, MN 55356- <br /> 952) 249-4600 FAX: (952 249-4616 <br /> ADDRESS : 4565 BAYSIDE RD <br /> PIN : 06-117-23-21-0010 <br /> LEGAL DESC : BAYSIDE BERRY FARM <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW OR REPLACEMENT(SEPTIC SYSTEM) <br /> ACTIVITY : MOLIND SYSTEM-SEPTIC <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> HAYES& SONS EXC. INC. TOTAL 400.00 <br /> Payment(s) <br /> 263 82ND STREET S.E. CREDIT CARD 5293 400.00 <br /> MONTROSE,MN 55303- <br /> (763)479-1762 <br /> Minnesota State License#: sept-L640 <br /> OWNER <br /> DOUBECK,TIM& MARY <br /> 4565 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 sepazate <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 l80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conforman e with the State Building Code.This permit may be �]� <br /> revo y ti fo �lue c se. _ /'�/ <br /> � � <br /> ;� '�� �� U ��..�Q,�v �C�� �19� l� <br /> � <br /> A licant Permitee ' nature Date Issued By Signatu Date <br /> i I � <br />