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CITY OF ORONO PERMIT NO.: 2011-00110 <br /> _- 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE ISSUEn: 07/20/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRF.SS : 2650 FOX ST <br /> PIN � : 04-117-23-41-0003 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1249 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM- SEPTIC <br /> NOTE: 1) GAST PROPERTY LINE MUST BE VERIFIED BEFORE INSTALLATION <br /> 2) SOILS MUST BE VERIFIED PRIOR TO INSTALLATION. <br /> (3)PRECAST TANKS-SIZE OF TANKS(1) 1250,(1) 125q AND(1) 1500 <br /> MOUND SYSTEM�1X 87S.F. <br /> APPLICANT <br /> SEPT[C NEW 200A0 <br /> BURNS EXCAVATING, INC. STATE SURCHARGE SEPTIC 0.50 <br /> 3470 CO. RD 21 TOTAL 200.50 <br /> MAYER, MN 55360- <br /> (612)685-4303 <br /> Minnesota State License#: 1888 <br /> OWNER <br /> PAULSON, STEPHEN <br /> 2650 FOX ST <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issucd 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 whcther or not specil7ed herein."Chis permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days oY 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.1�his permit may be <br /> revoked at any time for due cause. <br /> _� / / /� �j <br /> --� (/ 1��� ���� '� /� / / ��� � / <br /> Applicant Permitee Signature Date Issue �y Signa ure Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />