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. � CITY OF ORONO PERMIT NO.: 2011-00626 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE tSsuEn: 07/2U20ll <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 519 FERNDALE RD N <br /> PIN : 36-118-23-14-0008 <br /> LEGAL DESC : UNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM -SEPTIC <br /> NOTF: (3) NRECAST TANKS- 1,000 GALLON <br /> MOUND SYSTEM-500 SQ FT <br /> APPLICANT SEPTIC NEW 200.00 <br /> PATNODE BROS STATE SURCHARGE SEPTIC 0.50 <br /> 23200 109TH AVE <br /> ROGERS, MN 55374 TOTAL 200.50 <br /> (763)428-7393 <br /> Minnesota State License#: 95 <br /> OW1vER <br /> MICHELETTI, TOM <br /> 519 FERNDALE RD N <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issucd shall be performed according to <br /> the approved plans and specitications,applicabie City approvals,and the <br /> State[3uilding 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 /> suspended for a period of l80 days at any time after work has commenced. <br /> "I'he applicant is responsible for as ng all required inspections are <br /> requested���mance with e St te Building Code.This permit may be <br /> revoke e c use. -- <br /> ;, .�-� �, ` ��� � 7 ��o � l <br /> Ap icant Permitee Signature Date Issu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />