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� • ' ' CITY OF ORONO PERMIT NO.: 200�-002�4 <br /> ' 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: OS/15/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 145 MANOR CIR <br /> PIN : 04-117-23-11-0009 <br /> LEGAL DESC : COUNTRYSIDE MANOR 2ND ADDN <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <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 5530� MISC FEE 0.00 <br /> (763)479-1762 TOTAL 200.50 <br /> Minnesota State License#: 640 <br /> OWNER <br /> NASSAUER,KERRY&KI <br /> 145 MANOR CIR <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 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 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked a any t'me for due cause. <br /> � � �s- � �F � � /.5'� D � <br /> Applicant ermitee Signature Date I ed By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />