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CITY OF ORONO PERMIT NO.: 2009-00434 <br /> � - 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE IssuEn: 07/29/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2640 FOX ST <br /> PIN : 04-117-23-42-0008 <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 /> ACTNITY : MOUND SYSTEM - SEPTIC <br /> APPLICANT SEPTIC NEW 200.00 <br /> PATNODE BROS STATE SURCHARGE SEPTIC 0.50 <br /> 23200 109TH AVE <br /> ROGERS, MN 55374 TOTAL 200.50 <br /> (763)428-7393 <br /> Minnesota State License#: 95 <br /> OWNER <br /> WESTLING, TOM <br /> 2640 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 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 specificd 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 atter work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conforman with the State Building Code.This permit may be <br /> revoked at s . �-. y _ � <br /> / _�i� �l�� l O� `- � � <br /> Applicant Permitee Signature Date ��� �����"� / / <br /> Issued By gnature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />