HomeMy WebLinkAboutRe: refund request �.� ��,�"�<<�I �5
June 16, 2015
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Peter,
Attached is a refund request from Brad Hayes,for permit#2013-01223 located at 385 Stubbs Bav Rd N.
Per the attached letter they will not be doing the work on this project.
They would like a refund. Roger has agreed to refund the cost of the permit, minus the State Surcharge
and Mail-In Fees.
Please refund Hayes&Sons$200.00 for the cost of the permit only.
Thank you,
���c.c.�.e,,e��f�R--
Rachel Dodge
Administrative Assistant
Send refund check to:
Hayes&Sons Exc., Inc.
263 82"d Street SE
Montrose, MN 55303
CITY OF ORONO * Z 0 1 3 - 0 1 Z Z 3 *
2750 KELLEY PARKWAY DATE ISSUED: 10/07/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDR�,SS : 385 STUBBS BAY RD N
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P[IV : 32-118-23-31-0001
LEGAL DESC : UNPLATTED 32 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : SEPTIC
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : NEW OR REPLACEMENT(SEPTIC SYSTEM)
ACTIVITY : MOUND SYSTEM-SEPTIC
NOTE: (3)PRECAST CONCRETE TANKS
1,000 GALLONS EACH
MOUND TREATMENT SYSTEM-380 SQUARE FEET
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APPLICANT SEPT[C NEW OR REPLACEMENT 200.00
STATE SURCHARGE SEPTIC 5.00
HAYES& SONS EXC. INC. MISC FEE 0.00
263 82ND STREET S.E.
MONTROSE, MN 55303- TOTAL 205.00
(763)479-1762 Payment(s)
Minnesota State License#: L640 CREDIT CARD 5293 205.00
OWNER
CESSOR-CULVER, DEREK& BRIDGET
385 STUBBS BAY RD N
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perforrned according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ /
Applicant Permitee Signature Date [ssued By Signature Date
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'� Project Project No Page
�),�'L� Client Prepared by Date � � � � �
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� Calculations for Reviewed by Date
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