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CITY OF ORONO * z 0 1 3 — PJ 0 0 5 9 * <br /> 2750 KELLEY PARKWAY �ATE �ssu��: O1/23/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1860 FOX ST <br /> PIN : 03-117-23-42-0016 <br /> LEGAL DESC : WALDRON WOODS <br /> : LOT 2 BLOCK i <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM - SEPTIC <br /> NOTE: (3)PRLCAS'C CONCRf?ll?"I�nNKS- 1250, 1000, 1000 <br /> MOUND SYSTEM-630 S.1'. <br /> APPLICANT SEPTIC NEW 200.00 <br /> BURSCH BROTHERS INC. STATE SURCHARGE SEPTIC 5.00 <br /> P.O. BOX 55 TOTAL 205.00 <br /> HANOVER, MN 55341 <br /> (612)221-1493 <br /> Minnesota State License#:2727 <br /> OWNER <br /> OLSON, MICHAEL&JENNIFER <br /> 3924 UPTON AVE S <br /> MINNEAPOLIS, MN 55410- <br /> AGREEMENT AND SWORN STATEMENT <br /> The�cork for which this permit is issued shall be perfurmed accordin�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 separatc <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specificd herein.'1'his permit will <br /> expire and become null and void ifconstruction authorized is not <br /> commenced within 180 days of the dale 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 rcquircd inspections are <br /> requested in conformance with the State Building Code.This perniit may be <br /> revoked at any time for due causc. <br /> X-�;,,,� � l / Z 3 / 1� / / <br /> Applicant Permitec Signature Date <br /> Issucd 13��Signaturc Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />