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% PERMIT <br /> CITY OF ORONO Permit Number: <br /> 2750 Kelley Parkway- PO Box 66 P05665 <br /> Crystal Bay, Minnesota 55323 i Permit Type: Septic <br /> (952) 249-4600 Date Issued: 9/25/2002 <br /> SITE ADDRESS: 405 Old Crystal Bay Rd S <br /> LONG LAKE,MN 55356 <br /> PID: 04-117-23-24-0004 <br /> DESCRIPTION: <br /> Proposed Use: Residential <br /> Permit Class: General <br /> Permit Type: Septic Permit Sub-type(s): New Septic System <br /> DETAILS: <br /> Approved per resolution#: <br /> Separate permits required: <br /> NOTICES/REMARKS: <br /> FEE SUMMARY: Permit Fee: $ 100.00 <br /> Valuation: $ 0.00 <br /> State Surcharge Fee: $ 0.50 <br /> TOTAL FEE: $ 00.50 <br /> APPLICANT: Kothrade Sewer&Water OWNER: CAROLYN KOZLOSKI <br /> 12059 Whitetail Avenue 405 OLD CRYSTAL BAY RD S <br /> Hanover,MN 55341 LONG LAKE MN 55356 <br /> THE , 0 E' IGNED HEREBY REQUESTS PERMISSI oN TO MAKE THE REAL IMPROVEMENTS SPECIFIED <br /> AND GREE. TO DO AL WORK IN STRICT o•MPL 1ANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF <br /> M *II SOT. B /DIN D ' I IRE 0, S. <br /> I <br /> / <br /> ' ° 1 4' • ,,, '9,e r)ma,-(-- COS-) <br /> \• •PLICANT EE SIGNATURE ISSUED BY SIGNATURE <br /> Copies: 1-File(Siznitures Required).1-Applicant, 1-Monthly Reports, 1-Assessin¢, 1-Finance Page 1 <br />