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�'� .� . ! CITY OF ORONO * 2 0 1 5 - 0 0 5 5 4 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/27/2015 <br /> ORONO, MN 55356- <br /> 952 49-4600 FAX: 952 249-4616 <br /> ADDRESS : 1100 PINE VIEW'DR <br /> PIN : 28-118-23-42-OO�b <br /> LEGAL DESC : PINE VIEW <br /> : LOT 4 BLOC� 1 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW OR REPLA'CEMENT(SEPTIC SYSTEM) <br /> ACTIVITY : MOLTND SYSTEM-SEPTIC <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> STATE SURCHARGE SEPTIC 5.00 <br /> HAYES&SONS EXC.INC. ' TOTAL 405.00 <br /> 263 82ND STREET S.E. Payment(s) <br /> MONTROSE,MN 55303- CREDIT CARD 5293 405.00 <br /> (763)479-1762 <br /> Minnesota State License#:sept-L640 <br /> OW1vER <br /> WIGGINS,JASON&AMANDA <br /> 410 N 2ND ST <br /> UNIT 449 <br /> MINNEAPOLIS,MN 55401- <br /> AGREEMENT AND SWORN STATEM�NT <br /> The work for which this permit is issued shall be performed aCcording to <br /> the approved plans and specifications,applicable Ciry approv�ls,and the <br /> State Building Code. This permit is for only the work described and dces <br /> not grant permission for additional or related work which req�►ires sepazate <br /> permits. All provisions of laws and ordinances governing thiS type of work <br /> shall be compied with whether or not specified herein.'fhis pbrmit will <br /> expire and become null and void if construction suthorized 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 ha9 commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested in conformance with the State Building Code.This�permit may be <br /> revoked at any tim r due cause. <br /> �_��/S'- �',�� S <br /> Ap 'cant e i e Signature Date Issu y Signature Date <br />