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CITY OF ORONO PERMIT NO.: 2009-00262
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 06/01/2009
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 325 HOLLANDER RD
PIN : 25-118-23-43-0024
LEGAL DESC : REG. LAND SURVEY NO. 1281 �t�/
: LOT 000 BLOCK 000 3:3'S Di
PERMIT TYPE : SEPTIC
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : NEW
1000
._/ili 12-.9-7
APPLICANT SEPTIC NEW 200.00
PA BROS STATE SURCHARGE SEPTIC 0.50
2320000 109 109TH AVE TOTAL 200.50
ROGERS,MN 55374
(763)428-7393
Minnesota State License#: 95
OWNER
GOLINVAUX,MR.&MRS.
325 HOLLANDER RD
WAYZATA,MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed 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. a
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Applicant Permitee Signature Date Issued By Signatu a Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.