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• ' CITY OF ORONO PERMIT NO.: 20o9-oosg9 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE IssuEn: 09/30/2009 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3445 HIGH LA <br /> PIN : OS-117-23-12-0025 <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 SEPTIC 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 PAID WITH CC# 4286 <br /> OWNER <br /> BADEN, MICHEAL&JEANNIE <br /> 3445 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 /> the approved plans and specifications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work described and does <br /> not gran[permission for addi[ional or related work which reyuires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied wi[h 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 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 time for due cause. <br /> �� <br /> ��/� �,�''� � l�cl �C�� l l <br /> Applicant ermitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />