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CITY OF ORONO * z H 1 2 - 0 1 1 0 1 * <br /> � ' 2750 KELLEY PARKWAY DATE ISSUED: 10/30/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4360 CHIPPEWA LA <br /> PIN : 31-] 18-23-42-0015 <br /> LEGAL DESC : CHIPPEWA 3RD ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENT[AL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM- SEPTIC <br /> NO'1'I;: (4)PRECAS"C TANKS-(2)EXISTING 1000'S ARE OKAY-ADD(1) 1000 SGPTIC AND(1) 1�00 LIP"T <br /> 630 S.F. MOiJND TRF;ATMGNT SYSTEM <br /> APPLICANT SEPTIC NEW 200.00 <br /> HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 5.00 <br /> 263 82ND STREET S.E. <br /> MONTROSE, MN 55303- TOTAL 205.00 <br /> (763)479-1762 PAID W[TH CC# 5293 <br /> Minnesota State License#: L640 <br /> OWNER <br /> LEMOINE, DANA B <br /> 4360 CHIPPEWA LA <br /> MAPLE PLAIN, MN 55359- <br /> AGREEMENT AND SWORN STATEMENT <br /> l'hc�vork ibr���hich this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable Ciry approvals,and the <br /> Statc Building Code. This permit is for only the work described and does <br /> not grant permission for additional or rclated work which requires separate <br /> pennits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specitied herein.This pennit 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 contormance with the State Building Code.This permit may be <br /> revoked at any time f'or due cause. <br /> _._..,_. � / �v/ /D i 'a'�i ��- <br /> A ite � ig ature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />