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. . CITY OF ORONO PERMIT NO.: 2009-00576 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuEn: 09/15/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3405 HIGH LA <br /> PIN : OS-117-23-11-0002 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0843 <br /> : LOT 000 BLOCK 000 <br /> PERMiT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> APPLICANT SEPTIC NEW 200.00 <br /> BURNS EXCAVATING, INC. STATE SURCHARGE SEPTIC 0.50 <br /> 3470 CO. RD 21 <br /> MAYER, MN 55360- MISC FEE 0.00 <br /> O TOTAL 200.50 <br /> Minnesota State License#: 1888 <br /> OWNER <br /> REILLY, KEVIN& DENISE <br /> 3405 HIGH LA <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> [he 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 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 l80 days a[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[ime for due cause. <br /> � / / / / <br /> p icant Permitee Signature Date Issued By S' ature ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO . <br />