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� CITY OF ORONO PERMIT NO.: 2011-01004 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE ISSUEn: 10/03/2011 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2620 FOX ST <br /> PIN : 04-117-23-42-0010 <br /> LEGAL DESC : REG. LAND SURVEY NO. 1249 <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. <br /> MONTROSE,MN 5530:r TOTAL 205.00 <br /> (763)479-1762 PAID WITH CC# 5293 <br /> Minnesota State License#: 640 <br /> OWNER <br /> JAFFRAY, MR.& MRS. <br /> 2620 FOX ST <br /> WAYZATA, MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performcd according to <br /> the approved plans and specitica[ions,applicable City approvals,and the <br /> State Building Code. This permi[is for only Ihe work described and does <br /> no[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 wi[h wfiether 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 /> revo��d.at.� t�me f r due cause. <br /> . ., <br /> ��_..-, /' _ .__. ��j / .i /j� � <br /> ` = (� �Y�L-� ,j l l <br /> Applicant P � itee Signature Date Issued By ' nature � Date <br /> SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCR[BED ABO . <br />