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CITY OF ORONO PERMIT NO.: 2009-00363 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssUEv: 06/29/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 793 FERNDALE RD N <br /> PIN : 36-118-23-12-0016 <br /> LEGAL DESC : LAURANNE WOODS 2ND ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> `�, � V ` , _ -1 ;�"� � < f, �� <br /> e <br /> NOTE: DIRECT DRAINAGE FROM CULVERT AWAY FROM MOUND <br /> APPLICANT SEPTIC NEW 200.00 <br /> INGLESIDE ENGINEERING&CONST STATE SURCHARGE SEPTIC 0.50 <br /> 4920 HIGHWAY 55 <br /> P.O. BOX 127 TOTAL 200.50 <br /> LORETTO, MN 55357 <br /> (763)479-1869 <br /> Minnesota State License#: 874 <br /> OWNER <br /> GALES,ROBERT& SUSAN <br /> 793 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 permit is for only the work described and does <br /> not grant permission for additional or related wo�k which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specitied 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 all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / � / / <br /> Applicant Permitee Signature Date Issued By i nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB VE. <br />