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CITY OF ORONO 1111I I II �'! IIil <br /> 1 * 20 1 7 - 0 1 464 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 11/21/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4620 NORTH ARM DR W <br /> PIN : 06-117-23-23-0002 <br /> LEGAL DESC : UNPLATTED 06 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SEPTIC(NEW OR REPLACEMENT) <br /> ACTIVITY : SEPTIC(MOUND) <br /> NOTE: MOUND SYSTEMS <br /> (3)PRECAST CONCRETE TANKS <br /> 2250 COMBO <br /> 1000 LIFT <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> HAYES&SONS EXC. INC. TOTAL 400.00 <br /> Payment(s) <br /> 263 82ND STREET S.E. CREDIT CARD 5293 400.00 <br /> MONTROSE,MN 55303- <br /> (763)479-1762 <br /> Minnesota State License#:sept-L640 <br /> OWNER <br /> WINTER,DONALD <br /> 4620 NORTH ARM DR W <br /> MOUND, MN 55364- <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 be <br /> revoked at any time for due cause. <br /> � �� ,, 2 ,/,z�/ . - 7 <br /> A ltc$fft w;-` 'ee .4 ature Date / Iss d B .i ature Date <br /> PP <br />