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CITY OF ORONO I II� I�I I I I� I�I IIII I� II� II II <br /> • * 2 0 1 6 — 0 1 4 3 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 11/15/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 1175 MOONEY LAKE DR <br /> PIN : 25-118-23-41-0017 <br /> LEGAL DESC : MOONEY LAKE PRESERVE <br /> : LOT 8 BLOCK 1 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SEPTIC(NEW OR REPLACEMENT) <br /> ACTIVITY : SEPTIC(MOUND) <br /> NOTE: 10 X 63 MOUND <br /> 2- 1250 PRECAST TANKS <br /> 1 - 1250 PUMP <br /> 36-GPM <br /> #23 -TDH <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> BURNS EXCAVATING,INC. Payment(s) <br /> 3470 CO.RD 21 CHECK 27930 400.00 <br /> MAYER,MN 55360- <br /> (612)685-4303 <br /> Minnesota State License#: SW-1888 <br /> OWNER <br /> ADELMAN,TIMOTHY <br /> 4545 TRILLIUM DRIVE <br /> MEDINA,MN 55340- <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 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 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 he <br /> revoked at me for due cause. <br /> App icantermi.ee t ature Date Issued T Signature Date <br /> �/J <br />