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• CITY OF ORONO <br /> 11111111111111111111111111111111111111111111 <br /> * 20 1 7 - 00568 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/01/2017 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 540 OLD CRYSTAL BAY RD S <br /> PIN : 04-117-23-42-0030 <br /> LEGAL DESC : CRYSTAL BAY RETREAT <br /> : LOT 2 BLOCK 1 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SEPTIC(NEW OR REPLACEMENT) <br /> ACTIVITY : SEPTIC(MOUND) <br /> NOTE: MOUND SYSTEM <br /> RE-USING 2 EXISTING PRECAST TANKS <br /> ADD NEW LIFT STATION- 1,000 GALLON <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> HAYES&SONS EXC. INC. 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 /> GEORGE FUNK&JUDY ROGOSHESKE <br /> 540 OLD CRYSTAL BAY RD S <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 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 /> rev. . at an timedue use. <br /> I• RiAt) <br /> Ap icant Permitee Sim: ure Date Iss d B ignature Date <br />