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< <br /> CITY OF ORONO * z 0 1 6 - P1 1 2 3 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/03/2016 <br /> ORONO, MN 55356- <br /> � � (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4220 CHIPPEWA LA <br /> PIN : 31-118-23-42-0012 <br /> LEGAL DESC : CHIPPEWA 2ND ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SEPTIC(NEW OR REPLACEMENT) <br /> ACTIVITY : SEPTIC(MOUND) <br /> NOTE: (3)PRECAST CONCRETE TANKS- 1500, 1000, 1500 <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> CHUCK'S EXCAVATING Payment(s) <br /> 760 WEST 96TH STREET CHECK 5759 400.00 <br /> CHANHASSEN, MN 55317- <br /> (952)496-2874 <br /> Minnesota State License#: SW-L3320 <br /> OWNER <br /> DBG,LLC <br /> SCHRODER, SUSAN <br /> 4725 WEST LANE <br /> MINNETRISTA,MN 55364- <br /> AGREEMENT AND SWORN STATEME1vT <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 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 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 conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> _ ,,� r�.�--�� /D , � , l.C� <br /> Appl' ant Permitee Signature Date Issued B ignature Date <br />