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CITY OF ORONO *� 5 - 0 1 1 z 3 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/03/2015 <br /> � ^ ORONO, MN 55356- <br /> " (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 517 FERNDALE RD N <br /> PIN : 36-118-23-14-0007 <br /> LEGAL DESC : UNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW OR REPLACEMENT(SEPTIC SYSTEM) <br /> ACTNITY : MOLJND SYSTEM-SEPTIC <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> BURNS EXCAVATING, INC. Payment(s) <br /> 3470 CO. RD 21 CHECK 26739 400.00 <br /> MAYER, MN 55360- <br /> (612)685-4303 <br /> Minnesota State License#: SW-1888 <br /> OWNER <br /> ANDERSEN, STEVEN&STACIA <br /> 517 FERNDALE RD <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 onty 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 not <br /> commenced within l80 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 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 i1 in <br /> revoked at any time for due cause. ��'y� <br /> . _.. ,-�` <br /> �' �� � _' � � <br /> ��----__---- ___..._ _ �� J�_ �j � � ,r S <br /> Applicant Permitee Signature Date Issued By Signature Date <br />