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CITY OF ORONO * z 0 1 z - 0 0 7 8 1 * <br /> � 2750 KELLEY PARKWAY ppTE tssUEn: 08/23/2012 <br /> , ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1925 FOX ST <br /> PIN : 03-117-23-43-0002 <br /> LEGAL DESC : UNPLATTED 03 1 17 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM -SEPTIC <br /> NO"I�E: MOUND SYSTEM 37 S 74 <br /> APPLICANT SEPTIC NEW 200.00 <br /> BURNS EXCAVATING, INC. <br /> 3470 CO. RD 21 STATE SURCHARGE SEPTIC 5.00 <br /> MAYER, MN 55360- TOTAL 205.00 <br /> (612)685-4303 <br /> Minnesota State License#: 1888 <br /> OWNER <br /> WATSON,J WAGSTROM ASHDOWN <br /> 1925 FOX ST <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 Ciry approvals,and the <br /> State Building Code. This permit is for only the work describcd and does <br /> not grant permission for additional or related work which requires separate <br /> permi[s. 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 180 days at any time afier 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 /> �' / �2.3/ % Z ' ' � � � � <br /> �i,' �—� ��� ,.xJ� c�:�� � "� / <br /> Applicant Permitee Signature Date �� � <br /> [ssued By Signature Date <br /> SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />