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CITY OF ORONO 1 1'� I� � �i � I �� X 1 1 I1 1 <br /> * 20 1 4 - 0 1 1 8S * <br /> 2750 KELLEY PARKWAY <br /> DATE ISSUED: 10/15/2014 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 1130 OLD CRYSTAL BAY RD S <br /> PIN : 09-117-23-14-0007 <br /> LEGAL DESC : COLWELL ADDN <br /> : LOT 000 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM -SEPTIC <br /> NOTE: 3- 1,000 GALLON PRECAST CONCRETE TANKS <br /> I - 1300 GALLON PUMP TANK <br /> ROCK BED- 10 X 63 <br /> APPLICANT SEPTIC NEW 200.00 <br /> STATE SURCHARGE SEPTIC 5.00 <br /> KOTHRADE SEWER&WATER TOTAL 205.00 <br /> 12059 WHITETAIL AVENUE <br /> Payment(s) <br /> HANOVER, MN 55341 CHECK 18944 205.00 <br /> Minnesota State License#: SW-192 MPCA <br /> OWNER <br /> Spotted Dog LLC <br /> 1907 E WAYZATA BLVD <br /> #300 <br /> WAYZATA,MN 55391- <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 /> • sp= ded for a period of 180 days at any time after work has commenced. <br /> The a,I licant is responsible for assuring all required inspections are <br /> request d in onformance ith the State : ding Code.This permit may be <br /> yoke. ata t. - o du- cause. <br /> �. <br /> . .. , A`.4.4 IO IC / 4�-ysv-{--<-5�I esr /D /,- - /j/ <br /> Al: licant P -". 'ignature •.te Issued By Signature Date <br />