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, , CITY OF ORONO * z 0 1 z — m 0 e 7 5 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 09/06/2012 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS� : 4320 SIXTH AVE N <br /> PIN : 31-118-23-12-0009 <br /> LEGAL DESC : SHARON HILLS <br /> : LOT 004 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> NOTE: NEW MOUND SYSTEM <br /> (3)PRECAST CONCRETE TANKS-DARWIN <br /> 1300 - 1000 - 1300 <br /> 380 S.F.TREATMENT SYSTEM <br /> APPLICANT SEPTIC NEW 200.00 <br /> HAYES&SONS EXC. INC. STATE SURCHARGE SEPTIC 5.00 <br /> 263 82ND STREET S.E. TOTAL 205.00 <br /> MONTROSE,MN 55303- <br /> (763)479-1762 PAID WITH CC# 5293 <br /> Minnesota State License#: L640 <br /> OWNER <br /> DETERMAN,MR.&MRS. <br /> 4320 SIXTH AVE N <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 dces <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming 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 aze <br /> requeste 'n wnformance with the State Building Code.This permit may be <br /> r o t' e for ause. <br /> i '� i ��% �.� �/ <br /> plicant Pe itee Signature Date Issu By Sign re Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />