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CITY OF ORONO PERMIT NO.: 200&00181 <br /> _ 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssvED: 09/18/2008 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 645 FERNDALE RD N <br /> PIN : 36-118-23-11-0032 <br /> LEGAL DESC : N/A <br /> : LOT 000 BLOCK 000 gpnn�C <br /> PERMIT TYPE : SEPT[C <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> NOTE: INSTALLING(3)PRECAST CONCRETE TANKS, 1000 GALLONS-MOUND TREATMENT SYSTEM-500 S.F. <br /> APPLICANT SEPTIC NEW 100.00 <br /> HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 0.50 <br /> 263 82ND STREET S.E. TOTAL 100.50 <br /> MONTROSE, MN 55303 <br /> �i.t; I o�— i� `5�--cj;�� <br /> Minnesota State License#: 640 <br /> OWNER <br /> PAGE,TOM <br /> 645 FERNDALE RD N <br /> WAYZATA, MN 55391- <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 permi[is for only the work described and does <br /> not gran[permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming 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 180 days at any time after work has commenced. <br /> The applicant is responsible for assuring ail required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at a time for ue cause. ' __ �'r) � <br /> � �l �d / ��O ',� ( f_ l� _b �, <br /> - _,L L L L�. `� / / <br /> Applicant Pe ' ee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />