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CITY OF ORONO <br /> r 2750 KELLEY PARKWAY * 2 0 1 2 - 0 0 6 9 8 <br /> DATE ISSUED: 07/23/2012 <br /> ORONO,MN 55356- <br /> 952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS 340 TURNHAM RD <br /> PIN 31-118-23-42-0007 <br /> LEGAL DESC UNPLATTED 31 118 23 <br /> LOT 000 BLOCK 000 <br /> PERMIT TYPE SEPTIC <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE NEW <br /> ACTIVITY MOUND SYSTEM-SEPTIC <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 /> LEMOINE,DAINA <br /> 4360 CHIPPEWA LA <br /> MAPLE PLAIN,MN 55359- <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 /> revoked at any time for due cause. <br /> Applicant Pennitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />