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CITY OF ORONO * Z 0 1 5 — 0 0 6 2 6 * <br /> � 2750 KELLEY PARKWAY DATE [SSUED: 07/08/2015 <br /> ' ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 801 FERNDALE RD N <br /> PIN : 36-118-23-11-0027 <br /> LEGAL DESC : LYDIARD HILLS <br /> : LOT 002 BLOCK 001 <br /> PERM[T TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW OR REPLACEMENT(SEPTIC SYSTEM) <br /> ACTIVITY : OTHER-SEPTIC <br /> NOTE: PRESSURE BED SYSTEM- 1500 S.F. <br /> (2)PRECAST CONCRETG TANKS 1300 GALLON <br /> (I)PRECAS"[�CONCRE'1'F_,TANK- 1500 GALLON <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> KOTHRADE SEWER& WATER Payment(s) <br /> 12059 WHITETAIL AVENUE CHECK 19455 400.00 <br /> HANOVER, MN 55341 <br /> �) <br /> Minnesota State License#: SW-192 MPCA <br /> OWNER <br /> DI' BACCO, SHERRY <br /> 801 FERNDALE RD N <br /> WAYZATA, MN 55391- <br /> AGREEMENT AND SWORN STATEMEIYT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable Ciry 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 construc[ion 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 Wi t tate Building Code.This permit may be <br /> revoked at a time for d s � ��j / <br /> � � c �� � � �- ` <br /> ��- �i �_ A � �_ �_�- ����' � / �d / � __� <br /> Applicant Permitee Signature Date Issued By Signa ure Date <br />