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• � CITY OF ORONO PERMIT NO.: 2009-00588 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUEu: 09/30/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 3420 H[GH LA <br /> PIIV : OS-117-23-12-0026 <br /> LEGAL DESC : N/A <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 /> HAYES& SONS EXC. INC. STATE SURCHARGE SEPT[C 0.50 <br /> 263 82ND STREET S.E. <br /> MONTROSE, MN 55303- MISC FEE 0.00 <br /> (763)479-1762 TOTAL 200.50 <br /> Minnesota State License#: 640 PA[D WITH CC# 4286 <br /> OWNER <br /> WOLVERTON, WESLEY&EL[ZABETH <br /> 3420 HIGH LA <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AIVD SWORN STATEMENT <br /> Thc work for which this pemiit is issued shall be performed according to <br /> the approved plans and specitications,applicable City 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 /> permits. All provisions of laws and ordinances goveming 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 no[ <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 after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requcsted in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> f— \ �— �l / �G' /�l `� / / <br /> Applicant Permi ee Signature Date Issued F3y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />